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Human immunodeficiency virus p24 antigen testing in cornea donors
C W Chung1, C J Rapuano, P R Laibson
1Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
Cornea
|April 27, 2001
Summary
P24 antigen testing for human immunodeficiency virus (HIV) in cornea donors can lead to unnecessary tissue waste and difficult clinical decisions. Current guidelines for non-required screening tests in eye banking need further clarification.
Area of Science:
- Ophthalmology
- Virology
- Transplantation Immunology
Background:
- P24 antigen testing can detect early human immunodeficiency virus (HIV) infection but may yield false positives in cadaveric specimens.
- While not mandated by regulatory bodies, some tissue banks perform p24 testing on cornea donors, impacting eye banking practices.
Observation:
- Two corneal transplants were affected by delayed p24 reactivity results from other tissue banks.
- One recipient required a repeat corneal transplant due to a p24 reactivity report, though subsequent PCR testing was negative.
- Another case lacked sufficient specimen for confirmatory testing, with the recipient remaining seronegative for HIV.
Findings:
- The Lions Eye Bank of Delaware Valley initiated p24 and other non-required tests, leading to the discard of 22 corneas (11 donors) over two months due to reactive results.
- Reactive p24 tests led to discarding 4 donors, while 6 donors were reactive for hepatitis B core antibody, and 1 for syphilis.
Implications:
- Delayed reporting of p24 assay results can create challenging clinical scenarios post-transplantation.
- Implementing p24 testing for cornea donors may result in significant wastage of viable donor tissue.
- There is a need for clearer guidance on managing positive results from p24 and other non-required screening tests in eye banking.
