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HCV and HIV Coinfection

Just wondering if HCV And HIV coinfection can cause delayed seroconversion and what is the window period for HCV because i am getting mixed messages.Some say 7 days with a HCV RNA others say 3 to 6 MONTHS for an antibody test.
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1711722_tn?1356491154
Hi there.  I was prepared to tell you, "I have no idea what this means," but look what I just found (hope it helps):

Delayed seroconversion in HIV-positive individuals with acute HCV may result in delayed diagnosis and treatment. Where there is a clinical suspicion of recent HCV infection, for example, elevated alanine transaminase levels, HIV-infected patients should be screened for HCV RNA by RT–PCR.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646374/

Window period.  Antibody tests may give false negative (no antibodies were detected despite the presence of HIV) results during the window period, an interval of three weeks to six months between the time of HIV infection and the production of measurable antibodies to HIV seroconversion. Most people develop detectable antibodies approximately 30 days after infection, although some seroconvert later. The vast majority of people (97%) have detectable antibodies by three months after HIV infection; a six-month window is extremely rare with modern antibody testing.[5] During the window period, an infected person can transmit HIV to others although their HIV infection may not be detectable with an antibody test. Antiretroviral therapy during the window period can delay the formation of antibodies and extend the window period beyond 12 months.[6] This was not the case with patients that underwent treatment with post exposure prophylaxis (PEP). Those patients must take ELISA tests at various intervals after the usual 28 day course of treatment, sometimes extending outside of the conservative window period of 6 months. Antibody tests may also yield false negative results in patients with X-linked agammaglobulinemia; other diagnostic tests should be used in such patients.

Three instances of delayed HIV seroconversion occurring in health-care workers have been reported;[7] in these instances, the health-care workers[8] tested negative for HIV antibodies greater than 6 months postexposure but were seropositive within 12 months after the exposure.[9] DNA sequencing confirmed the source of infection in one instance. Two of the delayed seroconversions were associated with simultaneous exposure to hepatitis C virus (HCV). In one case, co-infection was associated with a rapidly fatal HCV disease course; however, it is not known whether HCV directly influences the risk for or course of HIV infection or is a marker for other exposure-related factors.

http://en.wikipedia.org/wiki/HIV_test

HIV prophylaxis. CDC guidelines generally recommend a PEP protocol with 3 or more antiviral drugs, when it is known that the donor was HIV positive; however, when the viral load was low and none of the above noted risk factors are met, the CDC protocol utilizes 2 antiviral drugs. Such a 2 drug protocol should also be considered when the donor status cannot be determined (i,e injury by a random needle in a used sharps' container), but there is an increased risk that the source was from a risk group for HIV.[16] PEP drugs for prevention of HIV infection are given for 4 weeks and may include nucleoside reverse transcriptase inhibitors (NRTIs), nucleotide reverse transcriptase inhibitors (NtRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and a single fusion inhibitor. PEP anti-HIV regimens are accompanied by significant side effects and their utilization is not indicated when there is evidence that HIV transmission is not involved; also, initiated protocols can be stopped when data appear indicating that the source-person is HIV-negative. Regardless whether PEP is instituted, follow-up of exposed individuals includes counseling and HIV testing by enzyme immunoassay to monitor for a possible seroconversion for at least 6 months after exposure. Such tests are done at baseline, 6 weeks, 12 weeks, and 6 months, and longer in specific circumstances, such as co-infection with HCV.

http://en.wikipedia.org/wiki/Needlestick_injury

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1711722_tn?1356491154
Hi there.  I was prepared to tell you, "I have no idea what this means," but look what I just found (hope it helps):

Delayed seroconversion in HIV-positive individuals with acute HCV may result in delayed diagnosis and treatment. Where there is a clinical suspicion of recent HCV infection, for example, elevated alanine transaminase levels, HIV-infected patients should be screened for HCV RNA by RT–PCR.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646374/

Window period.  Antibody tests may give false negative (no antibodies were detected despite the presence of HIV) results during the window period, an interval of three weeks to six months between the time of HIV infection and the production of measurable antibodies to HIV seroconversion. Most people develop detectable antibodies approximately 30 days after infection, although some seroconvert later. The vast majority of people (97%) have detectable antibodies by three months after HIV infection; a six-month window is extremely rare with modern antibody testing.[5] During the window period, an infected person can transmit HIV to others although their HIV infection may not be detectable with an antibody test. Antiretroviral therapy during the window period can delay the formation of antibodies and extend the window period beyond 12 months.[6] This was not the case with patients that underwent treatment with post exposure prophylaxis (PEP). Those patients must take ELISA tests at various intervals after the usual 28 day course of treatment, sometimes extending outside of the conservative window period of 6 months. Antibody tests may also yield false negative results in patients with X-linked agammaglobulinemia; other diagnostic tests should be used in such patients.

Three instances of delayed HIV seroconversion occurring in health-care workers have been reported;[7] in these instances, the health-care workers[8] tested negative for HIV antibodies greater than 6 months postexposure but were seropositive within 12 months after the exposure.[9] DNA sequencing confirmed the source of infection in one instance. Two of the delayed seroconversions were associated with simultaneous exposure to hepatitis C virus (HCV). In one case, co-infection was associated with a rapidly fatal HCV disease course; however, it is not known whether HCV directly influences the risk for or course of HIV infection or is a marker for other exposure-related factors.

http://en.wikipedia.org/wiki/HIV_test

HIV prophylaxis. CDC guidelines generally recommend a PEP protocol with 3 or more antiviral drugs, when it is known that the donor was HIV positive; however, when the viral load was low and none of the above noted risk factors are met, the CDC protocol utilizes 2 antiviral drugs. Such a 2 drug protocol should also be considered when the donor status cannot be determined (i,e injury by a random needle in a used sharps' container), but there is an increased risk that the source was from a risk group for HIV.[16] PEP drugs for prevention of HIV infection are given for 4 weeks and may include nucleoside reverse transcriptase inhibitors (NRTIs), nucleotide reverse transcriptase inhibitors (NtRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and a single fusion inhibitor. PEP anti-HIV regimens are accompanied by significant side effects and their utilization is not indicated when there is evidence that HIV transmission is not involved; also, initiated protocols can be stopped when data appear indicating that the source-person is HIV-negative. Regardless whether PEP is instituted, follow-up of exposed individuals includes counseling and HIV testing by enzyme immunoassay to monitor for a possible seroconversion for at least 6 months after exposure. Such tests are done at baseline, 6 weeks, 12 weeks, and 6 months, and longer in specific circumstances, such as co-infection with HCV.

http://en.wikipedia.org/wiki/Needlestick_injury

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Avatar_m_tn
Thankyou for the detailed information,there appears to be different opinions about the whole coinfection situation but i think it,s fair to say that with the HCV RNA the whole idea of delayed seroconversion might be a thing of the past.This test is able to detect the HCV around 7 days post-exposure i believe so the delay might just be another urban myth.
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Avatar_m_tn
Is the HCV RNA PCR 100% accurate and conclusive at 3 Months?
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Avatar_m_tn
Thanks Bill.
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