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Simian immunodeficiency virus (human HIV-II) transmission in allograft bone procedures
S D Cook1, S L Salkeld, A B Prewett
1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Study Design:
Infection of rhesus monkeys (Macaca mulatta) with simian immunodeficiency virus (SIV, HIV-II) was used to study disease transmission in allograft bone. Four allograft bone processing techniques--fresh, fresh frozen, double freeze-thaw, and double freeze-thaw with chemical decontamination--were evaluated.
Objectives:
To determine if SIV could be transmitted in allograft bone and if processing techniques could be used to eliminate the potential for disease transmission.
Summary Of Background Data:
Although the risk of HIV transmission in bone allograft was reported to be low, HIV transmission had occurred. In all cases, frozen allograft was used. Donor screening and serologic testing significantly reduced the risk of transmission, although a window of time existed in which an individual was infected but had not seroconverted. Experimental infection of rhesus monkeys with SIV induced a disease syndrome similar to AIDS and provided an ideal model to study disease transmission.
Methods:
Corticocancellous cylinders were obtained aseptically from SIV-infected rhesus monkeys. The grafts were randomly placed into one of four processing groups and implanted into noninfected animals. The presence of SIV antibody was monitored by serologic testing. After the monkeys were killed, the graft sites were studied by histology.
Results:
All animals receiving fresh allograft or allograft bone that had been subjected to either single or double -70 C freeze-thaw cycles became infected with SIV. Animals receiving allograft that had been subjected to a double freeze-thaw cycle and chemical decontamination were disease-free after 26 weeks when the animals were killed.
Conclusions:
The results show that SIV (HIV-II) can be transmitted in bone allograft procedures. Although freeze-thaw cycles and lavaging to remove blood elements can reduce the infectivity of a graft, it appears chemical decontamination is necessary to provide a high level of confidence in its safety.
Insights
Simian immunodeficiency virus (SIV) can transmit through bone allografts. Chemical decontamination is essential to ensure SIV-free bone grafts, as freeze-thaw cycles alone are insufficient for safe allograft procedures.
Area of Science:
- Virology
- Orthopedic Surgery
- Transplantation Immunology
Background:
- Human immunodeficiency virus (HIV) transmission via bone allografts, though rare, has occurred, primarily with frozen grafts.
- Donor screening and serologic testing reduce transmission risk but do not eliminate it due to the seroconversion window.
- Simian immunodeficiency virus (SIV) in rhesus monkeys serves as an ideal model for studying acquired immunodeficiency syndrome (AIDS) and disease transmission.
Purpose of the Study:
- To investigate the potential for simian immunodeficiency virus (SIV) transmission through allograft bone.
- To evaluate the efficacy of different bone processing techniques in eliminating SIV transmission.
Main Methods:
- Rhesus monkeys (Macaca mulatta) were infected with SIV to model disease transmission.
- Aseptic corticocancellous bone cylinders were obtained from infected monkeys.
- Grafts underwent four processing methods: fresh, fresh frozen, double freeze-thaw, and double freeze-thaw with chemical decontamination.
- Processed grafts were implanted into non-infected monkeys, and SIV antibody presence was monitored via serologic testing and histology.
Main Results:
- All animals receiving fresh or freeze-thawed allografts became infected with SIV.
- Animals receiving grafts treated with double freeze-thaw cycles and chemical decontamination remained disease-free.
- Histological examination confirmed the absence of SIV in the disease-free group.
Conclusions:
- Simian immunodeficiency virus (SIV) is transmissible via bone allograft procedures.
- While freeze-thaw cycles and blood element removal reduce infectivity, they are insufficient to guarantee graft safety.
- Chemical decontamination is crucial for ensuring a high level of confidence in the safety of bone allografts.