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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.

Click here for more Info on Hepatitis C

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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218 Comments

  1. Greetings doctor
    I had an hiv combo after 1 year and it was negative, incase of coinfection is the test result conclusive and there is no difference in the resault if the test methid is cmia and not elisa?

    the test is hiv combo 4th gen p24 Ab/Ag by abbot architect cmia and not elica… Any difference? Please notice its CMIA and not eliza.

    Thanks in advance

  2. Hi dr,

    I’d sex with a girl who I came to know later is HIV+. As soon as I finished sex i’d A slit on my penis and little bit of blood. Hence, I fear that HIV and HCV coinfextion could be possible.

    Tests done so far:

    HIV1/2, HCV, HBV (PCR qualitative test) – 11th day negative.
    HIV DUO test 29th day
    HIV DUO test 45th day
    HIV1 viral load test -73rd day ( less than 40 copies)
    HIV DUO test 89th day
    HBV, HCV antigen test – 96th day
    HIV DUO 120 day
    HIV DUO Test – 167 day
    HIv Duo test, anti HBV, anti HCV-181 day
    HIV1/2, HCV, HBV (PCR qualitative test) -217 Day
    HIV DUO test -217
    HCV antibody – 217
    These all came back negative but my ALT enzymes has gone up suddenly after 6 months.

    When I can have a conclusive test?

    • Your tests are conclusive already.

      • Thanks Dr, Jonathan for replying back. The HIV / HCV tests came negative till 7th month but I’ve just developed fatty liver. I’m quite lean and have not consumed alcohol from last 7 months. How can I develop a fatty liver without any reason.
        It seems that the HCV – Hiv seroconversion is delayed. That’s why I just want a confirmation what / which test will give me peace of mind?

        • Maybe you could ask your doctor how they even diagnosed fatty liver? Just because there is a slight raise in your liver enzymes does not equate to fatty liver. Also, fatty liver is not due to alcohol, but mainly genetics and diet. And fatty liver has nothing to do with hepatitis C or HIV diagnosis really. So what can I tell you that will give you peace of mind other than your tests are already conclusive?

  3. Hello doctor,
    Please i need your medical expertise on the subject.
    I had a protected anal intercourse with a CSW. At that time i had a genital herpes sore but i am not sure if it was exposed at any time during the intercourse.
    5 days later i had a mild fever (37) for 4-5 days. symptoms like fatigue, itchy skin, stomach pain come and go all that time.
    Tests:
    2weeks hiv1 proviral DNA pcr
    3weeks hiv1 RT-PCR RNA
    5weeks hiv1,2 ab-ag EIA / HCV / HBsAG / VDRL
    8weeks hiv1 RT-PCR RNA / hiv1,2 ag-ab
    8weeks hiv1,2 ag-ab ECLIA
    9weeks hiv1,2 ag-ab / hiv2 RT-PCR RNA
    10weeks hiv1,2 ab-ag EIA / HCV / HBsAG / VDRL
    15weeks hiv1,2 ab-ag
    23weeks INSTI hiv1,2 rapid test
    24weeks hiv1,2 ag-ab ECLIA
    7 months hiv1,2 ab-ag
    7,5 months hiv1,2 ab-ag HCV HBsAg VDRL
    7,5 months hcv HBsAg rapid test
    7,5 months AMPLISENS HCV/HBV/HIV1/HIV2-FTR KIT (PCR RNA)
    7,5 Months Full blood count ALL normal
    LIVER: AST:13 / ALT: 17/ GT:27 / ALP: 39
    All these tests have come Negative – non reactive so far.

    In case i contracted both hcv + hiv could all these tests still come negative?
    Have you heard of the Amplisens FTR kit? Are these multi-detection PCR tests reliable enough? should i test with an RNA test only for hcv detection?
    If hcv was present would liver enzymes be elevated or they could still be within normal ranges.

    Your opinion would really help me.
    Still cannot get back to my ordinary life. Keep reading about late seroconversion cases and i think i m one of these.

    Thanks in advance

  4. Greetings Dr.Tan,

    Does HCV/HIV coinfection delay the antibodies for HIV even with the HIV 4th generation combo p24 AB/AG test? Or if the antibodies delayed the antigen will be detected and should not worry and believe the tests?

    • Just to add the test is hiv combo 4thgen p24 Ab/Ag by abbot architect cmia and not elica… Any difference?

      Thanks in advance

    • The HIV antibodies may be delayed, but not the antigen – so a 4th gen test is still sufficient.

      • Thanks alot dr. But my last question what if the antigen not disappeard after 5 months or so and the antibodies delayed? Or the antigen will not disappear until the antiboies are detectable right?
        Just to get rid of the confusion and the anxiety

  5. Greetings Dr.Tan,

    Does HCV/HIV coinfection delay the antibodies for HIV even with the hiv 4th generation combo p24 AB/AG test?

    • It will still be detectable via the 4th gen test.

      • Sorry, you mean via the 4th gen ab/ag the hiv seroconv will not be delayed anymore because of the hepatitis (hcv) am i right?

        • Doc? Could you abswer my last reply please? With 4th gen combo test p24 ab/ag CMIA the window will not be affected because of the coinfextion hcv/hiv right?

  6. Hi doc you guys are remarkable!
    I need a little understanding about the 12 months.

    1. Is the article 12 months means at 12 months from the date of contracted co-infected source?
    (E.g. 1/2015(contracted from Source Date) then recommended testing at 1/2016)?? Regardless the HCV seroconvert date?

    OR let a person contracted at 1/2015 followed EIA HCV seroconvert at 6/2015(5 months later) then the HIV antibody testing is still at 1/2016? OR the recommended HIV testing should be 6/2016?

    Thank you so much of your effort who need answer doesn’t go unnoticed.

    • It is determined as 12 months from co-infection. However, the hep C window period is 3 months, so if you are negative for hep C at 3 months then you do not need to worry about any delay in window period for HIV.

  7. Repaly me iam wait your replay

  8. Hi sir…
    Only single (unprotected) exposer hiv and hcv transportation is possible.1.my 8 months hiv westren blot test is negative and 1 year hiv elisa test negative it is conclusive.
    2.1 year hcv tridot test is negative it is conclusive.
    3.hbsag and tpha antibodies test all negative it is conclusive.
    4.iam still super worrying pls replay me sir pls argent. I free from hiv 100% tell sir

  9. rrrraaaa

    Dear Doctor,

    I got a handjob from a massage lady on July 1 2017. I did 4th gen HIV test on 28 July and 1 Dec, 2017 (5 months). Both are non-reactive.
    1. Are my tests conclusive?
    2. Is there a possibility of HCV infection in the above encounter?
    3. Would HCV infection affect even the 4th gen HIV tests?

    Thank you doctor.

  10. Dear Doctor

    My 4th generation HBS Ag result is 0.01 at 101 days of needle exposure(Cut of value 0.13) Also 4th generation Hiv antibody is 0.06 and antigen not detected at 101 days.PCR RNA of HIV 1 is not derectable at 87 days.Kindly help to conclude the figure.

  11. Dear Dr.Tan
    I have 2 questions:
    1. had hep c before, is it still possible to infect acute hep c to make hiv window test be prolonged?
    2. I have 3 tests :
    30 days (4th combo test, negative)
    47 days (4th combo test, negative)
    84 days (antibody test, negative)
    Can I move on and can stopping worry about it?
    Thank you very much

    • Hepatitis C will usually result in chronic infection. Chronic hepatitis C does not extend the window period. I would not worry if I were you.

      • Thank you for your replying.
        My another question:
        is it any possible infect “another hep c “when I am chronic hep c (to cause acute hep c)?

  12. Hi Dr,

    If about 7 weeks ago, I was involved in some deep kissing and the person may have bled into my mouth and I have gum disease, would it affect my HIV results that I did? I had a 4th gen test done at about day 30 and it was negative.

  13. Good afternoon Dr Tan & partners,

    Thank you for your response on my previous query on the other blog.

    What about the common medical rule that the window period is supposedly at least 3 months, and therefore, checking before that period of time will not conclude anything? Especially if I’m also infected by Hepatitis C?

    Those info above are affirmed with the unwell symptoms the last 2 years.

    Please kindly expecting your feedback & info. Thank you.

  14. Greetings Dr.Tan,

    Does HCV/HIV coinfection delay the antibodies for HIV even with the combo p24 AB/AG test? or this applies only for old tests? im sorry but after reading this i really got confused!
    i tested after sexual exposure by 9 months and after 2 years.

  15. Hi dr.tan,

    First id like to say what youre doing is admirable. Making people aware of health status.

    Heres my question sir, i tested for hiv (Immunochromatography, sd hiv1/2) and anti hcv (cmia) 1year after exposure, am i clear for both viruses?

    Thsnk you sir.

    • Yes, your tests are conclusive. Thanks for the support.

    • Also, sorry for the last question, stated in your article that EIA antibody test is required to test for hcv. How is anti hcv (cmia) different from eia? Ty

      • Hi sir, sorry to follow up,but i think i forgot to mention both hiv1/2((Immunochromatography, sd ) and anti hcv (cmia)tests are non reactive. Does that mean negative?

        Lastly, stated in your article that EIA antibody test is required to test for hcv. How is anti hcv (cmia) different from eia?

        Thanks so much doctor.

  16. What is the effect of moringa on seroconversion?

  17. What is the effect of moringa on seroconversion

  18. VeryWorried

    Hello Doc… This information applies to any generation test? Have the fourth generation tests, which detect antibodies and antigen, such a long window period? Have you known, directly from your experience, cases of a retarded seroconversion, from 6 months to 12 months, with 4th generation tests?
    Thank you and greetings…

  19. Hello Doctor,

    If someone is suffering from co-infection of hcv and hiv without treatment how long the window period of HIV may increase?

  20. Worries

    HI doc,
    I have unprotected sex with a csw. After the sex I saw some blood. However, I did Alere combo test after 28days and the result was negative. I have also tested postive for gunorrhea after the incident.
    Now I have few question:
    1) is my 28 days result is conclusive?
    2) I didn’t have hep C before this. I’m afraid she might have transmitted to me since I saw blood. Is my window period for hiv increased?

    • Your test is a very good indication (99.8% accurate) at this point. It is highly unlikely you will be unlucky enough to have Hep C co-infection from this encounter. However, if you are concerned, then just repeat your test in a few weeks time.

      • Worried

        Sorry doc, I just read in ur website :
        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.
        So do I need to retest? If yes, then the window period for hiv coninfection is 12 months right?

        • You can repeat your test at 3 months if you are concerned. Test for HCV as well then you will have your answer and do not need to wait 12 months.

      • Worries

        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.
        1) hi Doc, it means the test does not affected due to co infection right?
        2) assuming it is affected, when should I retest?

        • You can repeat your test at 3 months if you are concerned. Test for HCV as well then you will have your answer.

  21. Hi, Dr Tan I have a small quick question. I have a suspect exposure to both HIV and HCV about “5 months ago”. As now I have heard about both virus can delay each other and plan to get both HIV and HCV test to stop my worry. My question is

    1. Should I take HIV RNA PCR together with HIV Ag/Ab test?
    2. Should I take HCV PCR Qualitative together with Anti-HCV test?

    The reason why I take PCR test for both virus is because I worry both might have delayed each other which may result in false negative test.

    Thank so much of your time.

    • We are unable to advise on the type of test that is recommended for you . You need to speak to your doctor on your exposure risk and they will advise on the type of test that you require.
      please visit us for a formal consultation . click here for the location.

  22. Hi Dr Tan,
    I have few question that I really hope you can help me with.
    I have heard you said with newer generation HIV test will solve delay of HIV window period.

    1. I have an exposure about 6 months ago if I have “HCV” but with ElISA 4th Generation HIV Ag/Ab test after “6 month” is negative are they consider conclusive?

    2. Even my HIV window period antibody extend due to HCV, after 6 month will 4th Generation test still found p24? As I heard after few weeks p24 start to disappear therefore the test will reply on development of antibody.

    3. Do 4th Generation combo test Ag/p24 work after 6 month of exposure? I mean after 6 month of exposure if my HIV antibody delay by HCV will the test still found p24? Because it’s quite some time already.

    Kindly advice and thank you very much 🙂

    • Apologies. This site is not for dispensing medical advice. If you suspect that you have been infected by HCV, you should see a doctor for a formal medical consult.

      My opinion is that your HIV tests are conclusive despite the presence of HCV. Again I stress that this is NOT medical advice.

  23. Hi Dr Tan,

    I have a few question which is a bit complicated to ask.

    I had sex once with sex worker 3 years ago and a year ago I receive oral sex from a massage center. I have tested HIV 1&2 AG/AB ELISA Test and result is NONREACTIVE. But recently I have seen your post about HCV might have delay HIV seroconversion and HIV window period might have to extended HIV Follow-up(e.g.for 12 months) is recommended. I don’t know whether I have been exposed to HCV or not so a week ago I have taken ANTI-HCV(EIA Antibody test) and result is NONREACTIVE but I did not take the HCV RNA PCR Qualitative test.

    HIV Ag/Ab ELISA= Nonreactive
    ANTI-HCV= Nonreactive

    But recently I have found some infro regarding about co-infection of HIV and HCV that HIV do delay HCV antibody also. The link is http://www.ncbi.nlm.nih.gov/pmc/article/PMC2646374/ My question is:

    1. Should I take HCV RNA PCR QUALITATIVE Test in order to verify that I really not infected by HCV? But according to CDC about 25% of HCV infected people they might be able to clear the virus by their own and this RNA test might appear to be “Negative”.

    If I take HCV RNA Test the result is “Negative” but now my Anti-HCV test= (NONREACTIVE) will it might delayed by HIV? As the above article stated that there will be a “Delayed Anti-HCV response in HIV POSITIVE men acutely infected HCV.

    2. I do know my HIV AG/AB ELISA =(NONREACTIVE) which will not alter my Anti-HCV Test. But what if I might have acquired Acute HCV earlier before HIV which might delayed my HIV Window period test?

    3. I do know HIV Ag/Ab test can solve the “Delayed antibody by HCV as it got p24 antigen to detect HIV instead of antibody. But p24 in 4th Generation HIV test reach peak at around three to four weeks after exposure and are usually not detectable after that therefore it stil has to depend on the ab(antibody) test for accurate result as the window period for p24 detected is very short and might not be able to detect overtime. But my exposure is 3 years ago and I can only depend on ab(antibody) only but just worry I might have HCV that delayed the HIV antibody. Is my assumption correct?

    I really trust you and deeply hope with your professional opinion will help me get through this. Thank you in advance for your time, sincere and professional opinion.

    • C’mon man! Really? You put in all this work and effort on researching reasons to scare yourself? You tested negative for HIV and HCV for an encounter 3 years ago. Be like any normal person i.e. celebrate and move on.

  24. Hi doc tan! 2 questions. 1) What can prolong hiv window period to 1 year? Hep c or hep c treatment? (According to aidsvancouver helpline, hep c treatment is the one that can prolong hiv window period to 6 months? 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!

  25. Hi doc! 2 questions. 1) What extends hiv window period to 1 year? Is it Hep c or hep c treatment that extends it ? 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! Also, according to aidsvancouver helpline, it is hep c treatment that causes for window period to extend to 6 months. Thanks!

  26. 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.

  27. 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.

  28. 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!

  29. 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.

  30. 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-

  31. 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-

  32. 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!

      • Stacey Lawrence

        Are you saying that both infection occur on the same day or at different times

      • Stacey Lawrence

        Are you saying the the window period is prolonged if both infections occurs on the same day. If it was approximately one year ago I was exposed to hep c and a year later i was exposed to hiv will the hiv window period be extended to a year?

  33. 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.

  34. 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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