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Please please please help 3rd attempt
Jul 28, 2010

I'm begging you for your help. I'm not going to lie and say that I will donate money in order to get an answer. If everyone on here that says they will donate actually did so, HIV/AIDS would be cured. I can, however, promise you my sincere appreciation and gratitude for your help.

I'm very concerned that I have hep c and HIV coinfection. In addition to HIV symptoms, I'm experiencing symptoms that are indicative of hepatitis c, including liver pain. I am desperately seeking answers, because I do not want to waste the next year of my life.

Now onto my question. You stated that,

"The health care worker guidelines for occupational exposure to coinfected patients suggest HIV-antibody testing at baseline, six weeks and twelve weeks after exposure. There is a caveat, however: If, and I must stress this "if," the health care worker develops acute hepatitis C infection, then and only then (I also stress the "then and only then") would additional HIV-antibody testing be recommend. In this case, and only in this case, are HIV tests out to 12 months recommended. Put another way, if the health care worker does not get ill with acute hepatitis C infection, additional tests would not be recommended!"

This is very clear - If you don't develop HCV, then HIV testing beyond 3 months in unwarranted.

However, the reason I'm confused by this recommendation is that HIV itself can ALSO delay hepatitis C antibodies from showing up in a HCV test longer than three months (sometimes out to a year) when both illnesses are contracted simultaneously. So how are we supposed to know that we don't have hep C and can rely on our three month HIV test?

The possibility that I have these disease and that I may have passed them onto others is destroying my life. I seriously cannot enjoy anything, because these illnesses are always in the back of my mind. Please help me.

Response from Dr. Frascino

Hi,

Your comment, "if everyone on here that says they will donate actually did so, HIV/AIDS would be cured," made me smile, because it's quite true. If not a cure, we would at least be handing out grants to rival the Bill and Melinda Gates Foundation! I very much appreciate your honesty and your gratitude.

Regarding hepatitis C/HIV coinfection, this has become a QTND (question that never dies). Here's the scoop: If you feel you have hepatitis, see your doctor. He can run simple blood tests (these are not hepatitis C-antibody tests!) to ascertain if your liver is inflamed. If it is not, you don't have acute hepatitis C. If you do have inflammation, he will examine you and run follow-up tests to ascertain the cause of the inflammation (hepatitis A, B, or C; non-infectious hepatitis, etc.). If and only if you have acute hepatitis C infection should you consider the possibility of testing out to 12 months, OK?

Hope that helps clarify things.

Dr. Bob

Guidelines may need to be revised or clarified Jul 27, 2010

Dear Doctor Bob,

I was really hoping for some clarification.

You stated in the archives (yes, I did check them) that,

"The health care worker guidelines for occupational exposure to coinfected patients suggest HIV-antibody testing at baseline, six weeks and twelve weeks after exposure. There is a caveat, however: If, and I must stress this "if," the health care worker develops acute hepatitis C infection, then and only then (I also stress the "then and only then") would additional HIV-antibody testing be recommend. In this case, and only in this case, are HIV tests out to 12 months recommended. Put another way, if the health care worker does not get ill with acute hepatitis C infection, additional tests would not be recommended!"

This is very clear - If you don't develop HCV, then HIV testing beyond 3 months in unwarranted.

However, the reason I'm confused by this recommendation is that HIV itself can ALSO delay hepatitis C antibodies from showing up in a HCV test longer than three months (sometimes out to a year) when both illnesses are contracted simultaneously. So how are we supposed to know that we don't have hep C and can rely on our three month HIV test?

I normally would not be too concerned by this, but in addition to HIV symptoms, I'm also exhibiting symptoms that are in line with HCV (i.e. liver pain). This is destroying my life and it just won't quit. I seriously cannot enjoy anything, because these illnesses are always in the back of my mind. I appreciate you help.

Response from Dr. Frascino

Hello,

Nope! The guidelines do not need revision.

You seem to be confused about a test result (detectable levels of hepatitis C antibodies) and an illness (acute hepatitis C infection). Please note the guidelines do not mention hepatitis C antibodies, but rather becoming clinically ill with acute hepatitis C. (This would involve physical symptoms, increases in liver function tests, etc.)

Your fears are unwarranted.

Dr. Bob



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