Negative HCV antibody; Positive HCV RNA PCR

[Mario-Almeida]

Posted by Mario Almeida on April 25, 1999 at 15:29:46
51 days after the risk situation I get for the HCV antibody test the following result: 0.12 < 1.1  (does this means negative?)
and a positive HCV RNA PCR (cut-off index 8.45).
3 months after the risk situation I get a negative HCV antibody test and a negative HCV RNA PCR in a different laboratory. Also HIV1 (antibody, antigen and PCR) and HIV2 (antibody) are both negative.
1 week after the risk situation ALT = 151 (upper limit 40)
3 monts after the risk situation ALT = 97 (upper limit 40)
Fatty liver is known from 1995
HBs Ag negative
HBe Ag negative
HBe Ab positive
Hbs Ab positive
HBc Ab positive
Is it possible to be in the window period for HCV, or any other explanation? Is it possible the HCV infection to delay the positivity of HIV testings?
Thanking you in antecipation,
Mario Almeida
Posted by HFHSM.D.-D.M. on May 02, 1999 at 15:45:57

Dear Mario Almeida:
I appreciate your questions.  Diagnosing hepatitis C early after an exposure can require a little extra effort and I appreciate the opportunity to make some comments.
There is a window period after exposure to hepatitis C in which it can take awhile for the antibody test to become positive.  With some of the early tests for hepatitis C, it could take many months for the antibody test to become positive.  The newer test are improved but it can still take over a month for many individuals to become positive.  However, the HCV RNA or PCR test should be positive within several weeks of the exposure.  In fact, the HCV RNA levels can be very high with an acute infection and this test is especially valuable in this setting.  By three months, both the current antibody tests and the PCR tests should have enough time to become positive.  I am encouraged that these tests are negative in your case.  
I have, however, continually stressed to MedHelp participants that the HCV RNA or PCR test is a complicated test and not all labs are equal in their ability to perform the test or in their quality control.  One of the best laboratories performing hepatitis C PCR is National Genetics Institute in Culver City, California.  They specialize in this test and perform it reliably.  If there is some doubt as to what is going on, you could have done your PCR test performed by them.  
To answer your final question, I know of no reason why an acute hepatitis C infection would interfere with any of the HIV assays though I do not know if this has been looked at in any detail.  
I hope this information is helpful to you.  Good luck with your situation.  If you have any additional questions or concerns, you can post them through MEDHELP or contact us directly at Henry Ford.  The direct number to our liver clinic is: [phone].  At Henry Ford, we have an active group of hepatologists with an interest in the care and research of hepatitis C.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question physician when you have a question pertaining to your health.