角膜捐献者中的人类免疫缺陷病毒p24抗原检测

Chung C W, Rapuano C J, Laibson P R, Lytle R E, Quirk J T, Cohen E J

Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.

Cornea. 2001 Apr;20(3):277-80. doi: 10.1097/00003226-200104000-00008.

PURPOSE

Testing for the p24 antigen of the human immunodeficiency virus (HIV) may detect early HIV infection in the seronegative window; however, falsely reactive results may occur in cadaver specimens. Although neither the Food and Drug Administration (FDA) nor the Eye Bank Association of America requires p24 testing of cornea donors, many tissue banks using other organs from cornea donors do perform this assay, and the FDA requires that eye banks reject corneal tissue if a reactive p24 assay is reported. We investigated the impact of p24 testing on eye banking and corneal transplantation.

METHODS

Two clinical cases and records from the Lions Eye Bank of Delaware Valley (LEBDV) were reviewed retrospectively.

RESULTS

Two corneas from the LEBDV were transplanted before the reporting of p24 reactivity by other tissue banks. In one case, because of the young age of the recipient, the surgeon elected to replace the cornea with new tissue hours after the original transplant, and later polymerase chain reaction (PCR) testing was negative. In the other case, there was not enough specimen to perform Western blot or PCR confirmatory testing. The patient was followed with periodic serologic testing for HIV and has remained seronegative. To avoid such problems in the future, the LEBDV initiated testing of all donors with p24 and other nonrequired screening tests. Over a 2-month period, 22 corneas (from 11 donors) were discarded because of these tests: 4 donors had reactive p24 tests, 6 were reactive for antibody to hepatitis B core antigen, and 1 had a reactive syphilis test.

CONCLUSIONS

Results from p24 assays by other tissue banks may cause difficult clinical situations when the results are received after transplantation of the tissue, but the use of the p24 assay in the screening of cornea donors may result in excessive waste of donor tissue. Further guidance is needed regarding the management of positive results from this and other nonrequired screening tests.

目的

检测人类免疫缺陷病毒（HIV）的p24抗原可在血清阴性窗口期检测出早期HIV感染；然而，尸体标本可能会出现假阳性结果。尽管美国食品药品监督管理局（FDA）和美国眼库协会均未要求对角膜供体进行p24检测，但许多使用角膜供体其他器官的组织库确实进行了该检测，并且FDA要求眼库在报告p24检测呈阳性时拒收角膜组织。我们调查了p24检测对眼库和角膜移植的影响。

方法

回顾性分析了特拉华谷狮子眼库（LEBDV）的两例临床病例及记录。

结果

在其他组织库报告p24反应性之前，LEBDV的两枚角膜已进行移植。其中一例，由于受者年龄较小，外科医生在原移植术后数小时选择用新组织替换角膜，随后的聚合酶链反应（PCR）检测结果为阴性。另一例，没有足够的标本进行蛋白质印迹法或PCR确证检测。对该患者进行了定期HIV血清学检测，结果仍为阴性。为避免未来出现此类问题，LEBDV开始对所有供体进行p24及其他非必需筛查检测。在两个月的时间里，有22枚角膜（来自11名供体）因这些检测而被丢弃：4名供体p24检测呈阳性，6名对乙肝核心抗原抗体检测呈阳性，1名梅毒检测呈阳性。