|Year : 2004 | Volume
| Issue : 1 | Page : 61-62
Seroprevalence of human immuno-deficiency virus, hepatitis B virus and hepatitis C virus among eye donors
B Mahalakshmi, Hajib N Madhavan, R Pushpalatha, S Margarita
Sankara Nethralaya, Chennai, India
Sankara Nethralaya, Chennai
Source of Support: None, Conflict of Interest: None
Blood specimens collected at the time of enucleation of the eyes from 483 consecutive eye donors were tested for sero-markers of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV). Antibodies to HIV1 were detected in 3 (0.62%), HBsAg in 17 (3.52%) and antibodies to HCV in 7 (1.45%).
Keywords: Eye donor serology, antibodies to HIV 1 & 2, HBsAg, antibodies to HCV
|How to cite this article:|
Mahalakshmi B, Madhavan HN, Pushpalatha R, Margarita S. Seroprevalence of human immuno-deficiency virus, hepatitis B virus and hepatitis C virus among eye donors. Indian J Ophthalmol 2004;52:61-2
The possibility of transmission of infections from donor tissue to recipient is an important issue in all types of organ transplantation, including the cornea. The cornea has been documented as the vehicle of transmission in 8 cases of rabies, 2 cases of Hepatitis B Virus and one case of Creutzfeldt-Jakob disease (CJD). ,,Serologic testing of cadaveric blood from eye donors aims to reduce the risk of transmission of some systemic infectious diseases. Though documented evidence does not exist of transmission of HIV and HCV infections from sero-positive donor cornea to the recipient, ,, there is a risk of transmission of these agents from infected eye donors. We performed the serological tests on their sera to determine the presence of these viral infections.
| Methods|| |
About 3 - 4 ml of blood was collected by subclavian /internal jugular vein puncture at the time of enucleation of the eye from 483 consecutive eye donors received during the period January 2001- May 2002 at the C. U. Shah Eye Bank, Sankara Nethralaya, Chennai. Of these donors, 242 (50.1%) were female and 241 (49.9%) male, ranging in age from 11 months to 97 years. The cadaveric blood samples were stored at 2-8°C and were tested and reported mostly within 12 hours of collection of the eyes and within 36 hours if any holiday intervened. Antibodies to HIV 1 (against gp120 and gp41) and HIV 2 (against gp36), were screened by HIV TRIDOT (J. Mitra and Co., India) and HIV 1 and 2 Bispot -Immunocomb (Orgenics, Spain). Positive samples were further tested by Western blot (Immunetics, USA.). HBsAg was screened by Hepacard (J. Mitra & Co, India) and antibodies to HCV by HCV TRIDOT (J. Mitra & Co, India). Positive serum samples were further tested by HBsAg '90 Immunocomb II (Orgenics, Spain) and HCV Immunocomb II (Orgenics, Spain) respectively. The tests were carried out according to manufacturers' instructions.
| Results|| |
Among the 483 serum samples, antibodies to HIV1 were detected in 3 (0.62%). Two samples were positive for antibodies to HIV1 by both HIV TRIDOT, HIV-Immunocomb and by Western blot and one sample by HIV-Immunocomb alone. HBsAg was detected by Hepacard in 17 (3.52%); among these only 12 were positive by Immunocomb. Antibodies to HCV were detected by HCV TRIDOT in 7 (1.45%), and among these only 5 were positive by HCV Immunocomb. All the positive sera were positive for only one of the three viruses- HIV/HBV/HCV. The cause of death of the sero-positive patients included cardio-respiratory arrest, stroke, renal failure and liver failure. None of the eye donors appeared to belong to the high-risk group based on the history elicited when the eyes were collected. Among the total 966 eyes from 483 donors in the study period, 540 eyes (55.9%) from 270 donors were rejected due to poor cornea quality, systemic infections, leukemia and positive serology for HIV/HBV/HCV. The rejection due to positive serology amounts to 5.6% (54 corneas from 27 donors).
| Discussion|| |
In 1999, a total of 16,352 eyes were collected all over India for corneal transplantation. If the results of this study are extrapolated to these eye donors, 915 (5.6% of 16,352) of them might have been infectious for one of these three viruses - HIV, HBV or HCV. The sero-prevalence of each of these three viruses in eye donors in the Western literature is: 0.3 - 3% of HIV1,,, 1.3 - 2% of HBV, and 0.92 - 2.1% of HCV., These figures are not too different from those obtained in this study.
HIV transmission is known to occur in organ transplantations, but the five recipients of cornea from HIV-positive donors did not seroconvert during a follow-up of 3-6 years., HIV has been detected in tears, conjunctiva and cornea of AIDS patients. HIV proviral DNA has been detected in about 86 - 95% of cornea from HIV 1 seropositive donors, hence there is a potential for transmission of HIV through corneal transplan-tation. HBV cDNA was detected in 6.6% of corneal epithelium and 14.8% of stromal epithelium of seropositive eye donors.,  Since HCV RNA has been detected in 34.5% in cornea as well as in the tears and aqueous humor of seropositive patients, it is essential to determine the infectious status of the eye donor with this virus.
The prevalence of positive serology, based on the primary screening methods using two test kits for HIV 1, one test kit each for HBV and HCV infections, was 0.62%, 3.52% and 1.45% respectively. The Western blot confirmation of HIV1 seroprevalence was 0.41%. Based on the second screening method for HBsAg and antibodies to HCV, the sero-prevalence was 2.48% and 1.03% respectively. These results indicate the need for serological testing for these three viruses at least by two different screening methods. Despite the discrepant test results, it would be prudent not to use the cornea of an eye donor whose serum is positive even by one test. The cost of the screening tests to detect the sero-markers of the three viruses at present is approximately Rs.530. We feel the Western blot to confirm HIV positivity is not a necessity for cadaveric blood, though this was done to complete the present study.
| References|| |
Lee HM, Naor J, Alhindi R, Chinfook T, Krajden M, Mazzulli T, et al. Detection of Hepatitis C virus in the corneas of seropositive donors. Cornea
Glasser DB. Serologic testing of cornea donors. Cornea
Armstrong SAM, Gangam N, Chipman ML, Rootman DS. The prevalence of positive Hepatitis B, Hepatitis C and HIV serology in Cornea donor prescreened by medical and social history in Ontario, Canada. Cornea
Chung CW. Rapuano CJ, Laibson R, Lytle RE, Quirk JT, Cohon EJ. Human Immunodeficiency virus p24 antigen testing in cornea donors. Cornea
Eye Bank Association of India. Medical standards of eye banking in India. Recommendations of the study group meeting, EBAI, L V Prasad Eye Institute, Hyderabad, India. July 22-23, 1999. pp 27 -28.
Mattern RM, Cavanagh HD. Should Antibody to Hepatitis B core antigen be tested in routine screening of donor corneas for transplant? Cornea
Essary LR, Kinard SJ, Butcher A, Wang H, Laycock KA, Donegan E, et al. Screening potential corneal donors for HIV-1 by polymerase chain reaction and a calorimetric microwell hybridization assay. Am J Ophthalmol
Khalil A, Ayoub M, el-Din Abdel-wahab KS, el-Salakawy A, Assessment of the infectivity of corneal buttons taken from hepatitis B surface antigen seropositive donors. Br J Ophthalmol