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TheGermDoctor
TheGermDoctor, Doctor
Category: Medical
Satisfied Customers: 1549
Experience:  17 years as a physician, Board Certified in both Internal Medicine and Infectious Diseases
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only HIV specialist, pls

Customer Question

hello doc, i have a question.. obviously. I had my HIV AB test at 10 months after exposure. now, i am reading that possible coinfection with HCV could delay the seroconversion and i never checked for HCV. I do have some pan in the right upper abdomen and some other symptoms.. like right soulder pain, vascularitis. It will be about 11 motnhs now after exposure...any evidence that my fears actually have a ground or i can relax at least in term of HIV?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 2 years ago.

Hello. I would like to help you find an answer.

 

I am an internist well trained in HIV. Would you like me to help?

Customer: replied 2 years ago.
Yes if you know the answer :-)
Expert:  TheGermDoctor replied 2 years ago.

If you have elevated liver enzymes, or have had a high risk exposure, then I would recommend testing for Hepatitis C.

 

But that is a separate issue- If your HIV antibody test was negative at 10 months- then that exposure did not cause HIV. I can certainly reassure you about that. Now of course if you had other subsequent exposures, that is a different issue. But a negative test at 10 months is pretty definite in my book

 

Good luck.

 

Always ask if you need clarification/more information.


POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an IN PERSON assessment by your doctor,
and does not establish a patient-physician relationship.

Customer: replied 2 years ago.
I don't know about enzymes. Going to ask for a test. I just need clarification fir my sick brain - no seroconversion delay even in case of confection? There are this 3 cases reported that made all this deal... But I got really scared that I might be not seroconverted yet. I am suffering from extreme anxiety since my last unprotected sex last November. Not that hep c better but at least to care about one infection, not two.
Expert:  TheGermDoctor replied 2 years ago.

For all intents and purposes there is no need to worry about a delayed seroconversion with co-infection.

A negative HIV test in anyone at 10 months is negative.

 

Always ask if you need clarification/more information.


POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an IN PERSON assessment by your doctor,
and does not establish a patient-physician relationship.

TheGermDoctor, Doctor
Category: Medical
Satisfied Customers: 1549
Experience: 17 years as a physician, Board Certified in both Internal Medicine and Infectious Diseases
TheGermDoctor and 8 other Medical Specialists are ready to help you
Customer: replied 2 years ago.
Doctor, thank you for reassurance. Can u pls, comment on those 3 cases of late seroconversion that were published? I am sure you have your opinion and heard others. They make a big mess for us.
Expert:  Dr Mask replied 2 years ago.
Hello,

Welcome to Justanswer

Yes you are right about the reported case as you can see here
http://www.nejm.org/doi/full/10.1056/NEJM199703273361304

So yes it is possible for the delay in seroconvertion for HIV.

Now at this point the best thing to be done can be, instead of going for HIV again you may get tested for HCV and if negative that would not only help you be at peace for HIV but also would help you be sure for no HCV infection.

Since in the people that converted late the HIV test came out positive in as late as 12 months. Its been only 10 months for you post exposure and since I can feel your anxiety at a level that may make it difficult for you to wait so the best thing would be to go for HCV and if negative then instead of waiting for 2 more months you can just relax.

LFTs may give a clue but most of the time the HCV infection may be silent with normal LFTs so i would suggest to go for the HCV test itself instead of picking the indirect approach of getting LFTs.


Hope this Helped

Kindly remember to click ACCEPT

Regards & Best Wishes
Dr MASK
Customer: replied 2 years ago.
I am going to. At this point I need to know the odds. The paper is from 1997... Then the window period was longer too. Thats why I am asking - are there any RECENT cases of delayed seroconversion due to confection. As I said, I would prefer to worry about one infection, not twi
Expert:  Dr Mask replied 2 years ago.
There have been only three such cases reported so far and all were among health care professionals.

None other have published so far. And yes you are right that the improvement in test technique has reduced the period.

Still you would agree that ignoring an issue or worrying about it unduly will not solve it but a cool and calculating mind would definitely do so.

The best thing to do in such a situation is to face it and be benefited as the earlier a disease is diagnosed the better is the prognosis.

Having said that, you may not have either. Still since both are serious diseases the earlier you get rid of the confusion the better and earlier you would be able to start enjoying your life in a better way.

instead of taking this as "I may have them both" you can take it as I may have neither and that this test for HCV would help me confirm that and then I can move on with my life instead of living in doubts for the next 2 more months.

You seem to be quite a reasonable, well informed and logical person so handling this situation both at the mental and the practical level may be difficult but not impossible for you.


Best wishes

Dr MASK
Customer: replied 2 years ago.
And I agree with every word. But again, just wanted to see if someone who sees HIV patients on regular basis would be concerned about 10 months test.
Expert:  Dr Mask replied 2 years ago.
In routine yes the expert before me was right in re-assuring about the test being negative at such a period post exposure however when it comes to ones health then it is his/her right to rule out every possibility.

I called you as well informed since you pointed out a fact that the expert before missed.

Since those cases point out a possibility so it is best to rule it out.

I work in a hospital responsible for health care of a million people on its panel but still I may have missed the point of this possibility for the co-infection since three cases out of so many diagnosed annually is pretty rare, but still a possibility as small as this needs to be ruled out.

So instead of being afraid of two infection and hence depriving oneself of the benefits of early institution of treatment modalities it would be best to go for the HCV test at this time and if negative (which hopefully would be) be done with it.

Hope this Helps you with this issue

Kindly do not forget to click accept

Regards
Dr MASK
Dr Mask, Doctor
Category: Medical
Satisfied Customers: 1433
Experience: MBBS with 06 years Clinical Exposure in Surgery & Internal Medicine
Dr Mask and 8 other Medical Specialists are ready to help you
Expert:  TheGermDoctor replied 2 years ago.

OK. A couple points.

 

The case described occurred in 1990-

The testing used then was first or second generation HIV tests- The accuracy of our tests now is markedly improved at improving sensitivity. To even compare is not appropriate.

 

And even still, in that case the patient seroconveted at 10 months- which you have passed now with a negative current test.

 

While it is never a good idea to say something is impossible, the likelihood is infinitesimal.

TheMask is unnecessarily scaring you and for all intents and purposes the risk is negligible.

 

It never hurts to re-test, but I stand by my initial comments, before DrMask rudely interjected.

 

Always ask if you need clarification/more information.


POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an IN PERSON assessment by your doctor,
and does not establish a patient-physician relationship.

Customer: replied 2 years ago.
Thank you Doctor! I also noticed that you have an expertise in HIV. Well... I will accept my negative results and I will work on HCV issue... I have a pain in my right abdomen going to the bak, lower part of rib case. And right shoulder painful too... I am lack oc appetite and a little nauseated but I started Citalopram 12 days ago which prolly coz Nasea and appetite change. Though pain not sharp but persistent and def look like liver....
Expert:  TheGermDoctor replied 2 years ago.

These abdominal symptoms likely should be investigated further- including an examination by a physician, and some blood work. You may as well need an ultrasound or a CT scan of the abdomen to examine the liver, gallbladder and pancreas.

 

Good luck.

 

Always ask if you need clarification/more information.

 

POSITIVE feedback & a BONUS are warmly appreciated.
Please note that answers are for information only, do not take the place of an IN PERSON assessment by your doctor,
and does not establish a patient-physician relationship.

TheGermDoctor, Doctor
Category: Medical
Satisfied Customers: 1549
Experience: 17 years as a physician, Board Certified in both Internal Medicine and Infectious Diseases
TheGermDoctor and 8 other Medical Specialists are ready to help you
Expert:  Dr Mask replied 2 years ago.
Here is a report published in 2004 for the same issue of late seroconvertion so I am sorry "the germ doctor" stands corrected.

http://www.healthsystem.virginia.edu/internet/safetycenter/internetsafetycenterwebpages/trainingeducationalresources/co-infection-with-hiv-and-hcv.pdf

Still if you wish to accept The germ doctor's opinion it is your choice.

Best wishes

Dr MASK
Expert:  TheGermDoctor replied 2 years ago.

This will be my last post on this issue-

 

TheMask's reference above is a review article from 2004, not original data from that time- and careful reading will show that the cases either occurred in the 1990s or in fact showed normal patterns of seroconversion.

 

I stand by my comments and would again reassure you that a negative test at 10 months is extremely reassuring.

TheGermDoctor, Doctor
Category: Medical
Satisfied Customers: 1549
Experience: 17 years as a physician, Board Certified in both Internal Medicine and Infectious Diseases
TheGermDoctor and 8 other Medical Specialists are ready to help you
Expert:  Dr Mask replied 2 years ago.
I would not have posted if there had not been this mis-information.

The article has been accepted for being published in 2004 because the idea still holds. And therefore no where in the article is it mentioned that the new more accurate tests hold the older finding un-true.

Regards
Dr MASK
Customer: replied 2 years ago.
I can do literature search myself, in fAct that's what I am doing for living since been a scientist. That's why I wanted the answer from someone who actually deal with HIV every day. Seems like germdoctor got an experience in the field. Please, correct if I am wrong. Even Since 2004 things changed...well... There is always chance to be the first or that something impossible will happened... But I am trying to hope here that I am ok...
Expert:  Dr. Phil, MD replied 2 years ago.
What else would you like to know?
Customer: replied 2 years ago.
It wAs a bit of discussion here... I think we are clear now. Thanks a lot.
Expert:  Dr. Phil, MD replied 2 years ago.
Ok.

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