Seroprevalence of HIV, HBV, HCV & RPR among cornea donor in the regional institute of ophthalmology

MH Patel; AM Patel; AM Shah

doi:10.4103/2347-6486.240223

Print ISSN: 2347-6486, Online-ISSN: 2347-6494

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ORIGINAL ARTICLE

Year : 2017 | Volume : 5 | Issue : 1 | Page : 39-43

Seroprevalence of HIV, HBV, HCV & RPR among cornea donor in the regional institute of ophthalmology

MH Patel¹, AM Patel², AM Shah³
¹ Associate Professor, Department of Microbiology, M & J Institute of Ophthalmology, B J Medical College, Ahmedabad, Gujarat, India
² Tutor, Department of Pathology & Microbiology, Govt. Dental College, Civil Hospital Campus, Ahmedabad , Gujarat, India
³ Associate Professor, Department of Pathology, M & J Institute of Ophthalmology, B J Medical College, Ahmedabad, Gujarat, India

Date of Web Publication

30-Aug-2018

Correspondence Address:
M H Patel
Abhiyaan Apt, Opp Paritosh So, Paliyad nagar Road, Naranpura, Ahmedabad, Gujarat
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-6486.240223

Abstract

Introduction: Donor corneas obtained by eye banks are steadily increasing all over the world. Proper evaluation of donor cornea is critical to the success of cornea transplantation.
Objectives: To analyse results of screening test done before corneal tissue transplantation.
Methods: Blood samples were collected at the time of enucleation of the eye from 947 consecutive cornea donors. The samples were tested for Antibodies of Human Immunodeficiency virus I & II (HIV), Hepatitis B virus (HBV), and Hepatitis C virus (HCV) & Treponema pallidum.
Results: In our study sero-prevalence of HIV, HBV, HCV & T. pallidum in eye donors are 1.58%, 0.52%, 0.10 and 0.21% respectively.
Conclusion: The study suggests that all the cornea donors should be screened for HIV, HBV, HCV & T. pallidum by serological test like standards followed in Blood banks of India.

Keywords: Screening test, Cornea donors, Serological marker

How to cite this article:
Patel M H, Patel A M, Shah A M. Seroprevalence of HIV, HBV, HCV & RPR among cornea donor in the regional institute of ophthalmology. J Integr Health Sci 2017;5:39-43

How to cite this URL:
Patel M H, Patel A M, Shah A M. Seroprevalence of HIV, HBV, HCV & RPR among cornea donor in the regional institute of ophthalmology. J Integr Health Sci [serial online] 2017 [cited 2023 Mar 22];5:39-43. Available from: https://www.jihs.in/text.asp?2017/5/1/39/240223

Introduction

The number of donor eyes procured by eye bank is gradually increased across the world due to enhanced public awareness. Safety and viability of the donor cornea is an essential prerequisite for successful outcome of corneal transplant procedure. Deceased eye donors by providing corneal graft to two recipients, deliver tremendous opportunities to morbid patient for sight restoration, but simultaneously also carry some unknown & unquantifiable risk of disease transmission to its recipient. Diseases with the potential for transmission by corneal transplantation fall into three main categories: infections, neoplasms and corneal disorders.

Among them, Transmission of infection through corneal transplant is a critical concern to cornea recipients.!

So, proper evaluation of donor cornea is mandatory & critical to get successful corneal transplantation, which include gross examination, slit lamp bio-microscopy, specular microscopy & screening of donor’s blood for deadly pathogen e.g. HIV, HBV, HCV & Treponema pallidum.^[2]

As per the standards published by the Eye Bank Association of America, USA, Screening for donor eye for HIV was started in 1985, HBsAg in 1986, HCV in 1991 followed by syphilis in 1992.^[3] The reason for donor syphilis testing emerged from the suggested correlation between syphilis and HIV seropositivity and the possibility that a positive syphilis serology might identify recently infected HIV-positive donor who had not yet converted to HIV seropositivity. A recent study, however, reported positive syphilis serology to be a poor marker for HIV-1infection and recommended re-evaluation of the decision of screening of potential cornea donors for syphilis.^[22] Testing for HCV antibody was deemed important when seroconversion (positive HCV antibody) was demonstrated in renal transplant recipients.^[23] However, to date no seroconversion has been shown following corneal transplantation. These standards are the benchmark for ethical & optimum eye bank practice and assuring acceptable levels of quality and proficiency in dealing with corneal graft for transplantation. There are few published data available regarding transmission of Hepatitis B Virus through donor’s corneal graft into recipients.^[4] Still there are no documented cases of transmission of HIV, HCV & T. pallidum during corneal transplantation, but there is always a risk from infected eye donor. So, all donor of cornea must be screened for presence of serological markers of HIV, HBV, HCV & Treponema pallidum. Routine Serologic testing of cadaveric blood from eye donors will reduce the risk of transmission of these deadly pathogens.^[5],[6]

Detection of these pathogens is to be done by detecting HBsAg for HBV, Ab for HIV I & II, HCV & Anticardiolipin Ab for syphilis.^[9] To determine the sero-prevalence of HBV, HIV, HCV & syphilis in eye donor population, we conducted a retrospective study of serological tests performed before corneal transplantation at Regional Institute of Ophthalmology, affiliated with a medical College in India. Total 947 donors were screened from September 2013 to March 2017.

Methodology

After receiving phone call from relatives of eye donor, a resident doctor conducted enucleation of the eye and about 5 ml of blood was collected in plain test tube by subclavian or internal jugular vein puncture. Cadaveric blood samples were stored in refrigerator between 2 to 8 degree Celsius and were tested and reported within 12 hours of enucleation of eyes.

Antibodies to HIV were screened by rapid immunochromatography method, which can detect as well as differentiate both HIV I & II in same testing procedure. HBV was screened for HBsAg by one step strip method and antibodies to HCV by rapid card method. Syphilis was screened for Anticardiolipin Ab (regain Ab) by Rapid Plasma Regain (RPR) test. All reactive samples were further confirmed by Enzyme Linked Immunosorbent Assay (ELISA) in case of HIV, HBV & HCV, while RPR reactive samples were confirmed by Treponema Pallidum Hemagglutination Assay (TPHA). All the tests were carried out as per manufacturer’s instructions.

Results

Results of 947 eye donors were as per follow. For Anti-HIV antibodies, 15 (1.58%) eye donors were reactive. All 15 cornea donors were reactive for HIV I only. None of cornea donors were reactive for HIV II. For HBsAg antigen, 5 (0.52%) eye donors were reactive. For Anti-HCV antibodies, 1 (0.1%) was reactive. For syphilis, 2 (0.21%) eye donors were reactive for RPR & TPHA. Out of 947 eye donor, 22 (2.32%) eye donors were rejected for transplant due to reactive serology tests; i.e. 44 corneas were rejected.

Figure 1: Percentage of donor cornea rejected due to positive serological test

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Discussion

In our study, sero-prevalence of HIV, HBV, HCV and Syphilis in eye donors was 1.58%, 0.52%, 0.1 and 0.21%. Out of 22 reactive test results, all donors were reactive for single serological test; none of donor was reactive for more than one serological test.

We had analyzed our data with similar study conducted in India as well as developed country. Amongst similar studies conducted in India, at RP centre, AIIMS, New Delhi, sero-prevalence of HIV, HBV and HCV was 0.12%, 0.49% and 0.9% & At Shankar Netralaya, Chennai, sero-prevalence of HIV, HBV and HCV was 0.62%, 3.52% and 1.45% respectively. Analysis of data of Eye Bank Association of Australia & Newzealand^[13], Eye banks of America^[3],[12] & Eye bank, Ontario, Canada^[8] are included in Table 1 & chart 1. Only Eye Bank association of America had published data for RPR Ab of Syphilis, which showed 1.1 % seropositivity. As other centers had not published data for RPR; so we could not be able to compare the data for same. Maximum sero-prevalence of HIV was observed in our study compared to other studies, which indicate increasing spread of HIV epidemic in India. Prevalence of HBV is nearly similar to other centers, except Shankar Netralaya, where it was 3.52%. We could not get any overt reason for the higher prevalence of HCV in our study as compared to other studies.

There has been circumstantial evidence for transmission of HBV by corneal grafts. HBsAg and HBV DNA have also been detected in corneas of infected donors. The detection of viral genome correlates with presence of virions and is, therefore good marker of infectivity of tissue.^[11]

Although corneas from HIV-1 sero-reactive donors are known to have been transplanted, recipients didn’t seroconvert and remained healthy. HIV-1 has been cultured from corneal specimens of carriers as well as AIDS patients. HIV proviral DNA has been detected in about 86-95% of corneas from HIV-1 sero-reactive donors hence there is a potential for HIV transmission through cornea transplant.

Apart from the HIV & HBV, following infectious diseases may have fatal outcome when contracted by cornea recipients : (a) Rabies (b) Hepatitis C virus - Although to date, there have been no reported cases of HCV transmission by cornea transplants, there is a potential risk since Hepatitis-C is life threatening. (c) Treponema pallidum (d) Creutzfeldt-Jakob disease ^{More Details} (e) Other virus diseases: Cytomegalovirus (CMV), Herpes simplex virus,^[14],[15] Herpes zoster virus^[16] Epstein-Barr virus,^[16] adenovirus,^[16] and rubella^[16] virus. (f) Diseases of possible but unproved viral etiology: Because of unconfirmed evidence several diseases including Reys syndrome, subacute sclerosing panencephalitis, progressive multifocal leukoencephalopathy, pseudopresumed histoplasmosis are linked to a possible viral etiology.^[16] (g) Septicemia: There is evidence in literature of possible cultures of same organism from blood of donor or donor corneal rim and host cornea implicating direct transfer of infecting organism from donor to host eye.^[17] Such an evidence has been documented for Streptococcus pneumonia,^[18] Pseudomonas

aeruginosa^[19] cryptococcus,^[20] and Torulopsis globorata.^[21] However, the risk at present of any of these viruses is not sufficient to warrant routine screening for eye transplant.

As per this study, 2.32% corneas were not used to be for transplant due to reactive serology tests. Amongst similar studies in India, at AIIMS, 1.51% corneas were rejected and at Shankar Netralaya, Chennai 5.59% corneas were rejected to reactive serology. Internationally, as per data of Eye bank of Australia & Newzealand, Eye bank of America & Eye Bank, Ontario, Canada 0.92%, 4.0% & 1.21% corneas were rejected respectively.

Conclusion

Our study shows that HIV is more prevalent in our cornea donor population followed by HBV and Syphillis. However, we could not detect the results of potential donors in window period of infection. Hence, p24 Ag detection & more advanced molecular diagnostic techniques like PCR and Nucleic Acid Amplification Testing (NAAT) should be proposed routinely to detect infection in window period. This would also reduce the risk of transmission to recipients of corneal graft.

References

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23.	Roth D, Fernandez JA, Burke GW, Esquenazi V, Miller J. Detection of antibody to hepatitis C virus in renal transplant recipients. Transplantation. 1991 Feb 1;51(2):396-400.

Figures

[Figure 1]

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