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HIV and Hep C coinfection window period

HIV Hep C Window Period

This is another question I see asked very often. Many people are afraid of being co-infected with HCV and HIV. After reading reports that HVC affects the HIV window period, they begin to suspect the validity of their HIV test results. Let’s find out the truth.

All this hullabaloo stems from a MMWR published by the CDC on 29th June 2001 titled Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis.

In this report, it is stated that ‘Extended HIV follow-up (e.g., for 12 months) is recommended for HCP who become infected with HCV following exposure to a source coinfected with HIV and HCV.’ In other words, ONLY in people acutely infected with HCV will the window period for HIV testing change.

So the real question to ask, if you really think this applies to you, is this: How can you tell if a person is infected with HCV?

Are there any symptoms of acute HCV infection? Most people actually suffer NO symptoms. Even if they have symptoms, it is usually mild and vague e.g. fatigue, loss of appetite, abdominal pain and rarely jaundice. So the absence or presence of symptoms is no help at all.

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You can test for HCV. The common cheaper test to do is the EIA antibody test. This is frequently accurate 4 weeks post exposure but might take up to 15 weeks. And there is the more expensive HCV RNA PCR test that can be done 2 to 3 weeks post exposure. (Updated 15th September 2014)

So if all these test come back clear for HCV, we can then conclude a person does NOT have HCV infection and therefore the window period for HIV testing will NOT be affected. If any of these tests come back positive, then a person is diagnosed with acute HCV infection and the HIV window period will be prolonged.

That said, is there a real need to be worried about HCV infection in the first place? HCV is mostly transmitted through needle sticks i.e. sharing of needles in drug users, needle stick injuries, contaminated tattoo needles, sharing razors, acupuncture etc. Less than 5% of HCV infections are due to high risk sexual exposure.

So if you really feel that you are at risk of both HCV and HIV, talk to Our Doctors about getting tested for HCV. If you are clear for HCV, then you do not need to worry about the window period for HIV being prolonged. If you test positive for HCV then you will need to see a Liver Specialist for further treatment. Also your HIV testing window period should be extended to 12 months.

Update 10th December 2014 – The latest published guidelines have not mentioned HCV prolonging the HIV testing window period. This could be due to the fact that most guidelines now recommend the 4th Generation combined Antibody/Antigen assay as 1st line screening for HIV infection.
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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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154 Comments

  1. Hello dr. tan. are there any uodates about this topic? i performed cunnilingus on a woman. Tested HIV negative 3 times up to 8 months. didn’t test for hcv at all. Are there still chances that I’m HIV positive and got false negatives? if there are chances are they realistic? also I’ve read that it isn’t recommended to even HCPs to extended hiv testing up to 12 montns any more. 3 months max

    • That’s right. With the newer generation HIV tests, this is no longer a problem. Also, there is no way you can get Hep C from cunnilingus or HIV for that matter.

  2. Good afternoon, Doctor,
    I received an oral sex from a female who i did not know her stats, I did HIV fourth generation test at week 11, and week 17 post exposure, also I did rapid HIV 1/2 test weeks 11, 12, 13,15,16,17 all came out negative, is my result conclusive?

    • Generally speaking yes they are. However, please verify this with the doctor who did the tests for you.

  3. Hi doc! 2 questions. 1) What delays hiv antibodies to 1 year? Hep c or hep c treatment? 2) the test alere hiv1/2 (not ag/ab), would you consider this a modern test that can no longer prolong window period to 1 year? (Due to the advent of better and more accurate test). Thanks doc!

    • 1) none
      2) I don’t understand your question. HIV antibody test is conclusive after 3 months.

      • Hi doc, according to the article dr.tan posted (If you test positive for HCV then you will need to see a Liver Specialist for further treatment. Also your HIV testing window period should be extended to 12 months). 1) What does this mean? Positive hcv can delay hiv antibodies/window period? Or hcv treatment can delay?

        2) & last question, accordingl dr.tan article also (http://www.drtanandpartners.com/hepatitis-c/) (In other words for patients who got infected with Hep C and HIV at the same time, they need to be screened for HIV for up to 12 months. Not the usual 3 months window period.
        —-Update March 2015
        In recent published guidelines on HIV screening, it is no longer mentioned that a Hepatitis C and HIV co-infection can prolong the HIV testing window period. This could be due to the advent of better and more accurate tests.) my 2nd question is,is alere hiv 1/2 (not ag/ab) considered better and more accurate? Thanks doctor!

  4. hello doctor
    i had protected sex with indian prostitute in her
    periods. after sex i noticed blood on my pubic
    area and pennis shaft after an hour later. i
    became very worried. i had cmia combo test 3
    months post exposure…is my test conclusive. im
    really wortied sbout delay seroconversion cases
    ….shloud i do pcr rna or dna test….pleases

    • I can only say superficially that the CMIA Combo test at 3 months is conclusive. However, I am in no position to verify the accuracy of your results. For that you have to ask the doctor who conducted the test for you.

  5. Hai Doc, i have a question regarding to co-infection HIV &HCV. I am afraid I might get this 2 infections in my anal sex methods. I don’t know there is a co-infections until i read your post. I did a Test only for HIV , HBV but not HCV. I did a 4th generation ag/ab hiv test on the 7.5 week of my post exposure (Non reactive ) & 9 week on HBV post exposure (non reactive) but HCV (Nill). I didn’t taken any medication expect gout medicine.

    1)If i get tested for reactive HCV,will it affects my 4th GEN HIV test window period to 12mon?
    2) is my HBV test conclusive?

    -Please & Thank you-

  6. Hai Doc, i have a question regarding to co-infection HIV &HCV. I am afraid I might get this 2 infections in my anal sex methods. I don’t know there is a co-infections until i read your post. I did a test only for HIV , HBV but not HCV. I did a 4th generation ag/ab hiv test on the 7.5 week of my post exposure (Non reactive ) & 9 week on HBV post exposure (non reactive) but HCV (Nill). I didn’t taken any medication expect gout medicine.

    1)If i get tested for reactive HCV,will it affects my 4th GEN HIV test window period to 12mon?
    2) is my HBV test conclusive?

    -Please & Thank you-

  7. Hi doctor,

    I was infected with Hep-c 5 years before and got treatment for 6 months 5 years ago. After that i am living a normal life and my LFT is normal. Now 4 months ago i had an hiv exposure. I took 4th generation tests at 29 and 86 days. Both were negative. Should I repeat my hiv test?

    • As far as I know, the HIV testing window period is prolonged only cases where HIV and Hep C are contracted at the same time. I do not think this applies in your case. Please verify this with your doctor.

      • Thank you doctor, I don’t have access to any HIV specialist. Since you are the expert in this field, please research this scenario not only for me but for future patients as well. I am interested in knowing that why delay seroconversion would happen in this case. Please reply back!

  8. Charles

    I almost forgot.
    Even if i catch HCV at the same exposure and develop acute hcv infection the hiv window period will extend?

    Even if i develop acute HCV my hiv results at 12 weeks are conclusive?

    • If you have a HIV / HCV co-infection, the HIV window period may be prolonged.

  9. Charles

    Hi Dr. Tan this is my situation about 3 monts ago i got pinched accidentally by a syringe previously used in a party (almost immediately.
    I have 3 HIV test negative
    15 days (antigen p24 by eclia)
    63 days (HIV 1 & 2 AB AG P24 by eclia)
    84 days (HIV 1 & ” AB AG P24 by eclia)

    All test negative by blood extraction of my vein.
    But my conserns start when I read that coinfection of HIV with HEP C may extend the window period fo HIV. In my web search I found yor website and some coments of your person telling to other people that coinfection HCV/HIV its not not longer a consern to afect the window period of a 4th gen test.

    1.- Should this applies in my case?
    2.- My HIV test are conclusive for hiv or my window period will extend 6-12 months also? i hope not.
    3.-Even if im infected with HCV the window period still 12 weeks for hiv with a 4th gen lab test?
    4.- Should i leave hiv problem and focus only on HCV?
    5.-My HIV test are conclusive?
    6.- Even if my window period extends doe to hcv or other coinfection the development of hiv antibodies the 4th gen test still found p24 antigen in my multiple lab test?

    I hope you will answer a soon as posible.
    thank you!

    • drtan

      1. Yes. 2. In my view your tests are conclusive. 3. Yes. 4. Yes. 5. Yes. 6. Yes.

      • Charles

        Thank you. i was wrong the hiv test i took were chemiluminiscence not cmia. this change your opinion?

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