POOR CORRELATION BETWEEN REACTIVE SYPHILIS SEROLOGY AND HUMAN-IMMUNODEFICIENCY-VIRUS TESTING AMONG POTENTIAL CORNEA DONORS

PURPOSE: The current practice in which eye banks screen cornea donors for syphilis is based mainly on the potential utility of positive syph ilis serology as a surrogate marker for human immunodeficiency virus-1 (HIV-1) infection. We examined the correlation between positive syphi lis and HIV-1 serologies within the potential cornea donor population. METHODS: We distributed a questionnaire to 94 eye banks in the United States regarding their rates of positive serology for syphilis and HI V-1 between Feb. 1 and July 30, 1992. We subsequently used the polymer ase chain reaction for HIV-1 to further evaluate the whole blood of 21 rapid plasma reagin and fluorescent treponemal antibody positive, HIV -1 enzyme linked immunosorbent assay (ELISA) negative cornea donors to determine whether these donors were infected with HIV-1 but were with in a seronegative window for HIV-1 antibodies at their time of death. RESULTS: Of 8,932 donors screened, 103 (1.15%) had reactive screening for syphilis serology and 35 (0.39%) were HIV-1 seropositive. No donor with positive syphilis serology was also HIV-1 seropositive. Twelve o f 31 donors who originally tested seropositive for syphilis by nontrep onemal screening tests (Venereal Disease Research Laboratory or rapid plasma reagin tests) proved seronegative for syphilis when further tes ted with a treponemal test (FTA-ABS or microhemagglutination-Treponema pallidum), suggesting a high (38.7%) false-positive rate for the syph ilis screening tests. Additionally, all 21 rapid plasma reagin and flu orescent-treponemal antibody-positive, HIV-1 ELISA-negative donors fur ther tested were also negative for HIV-1 by the polymerase chain react ion. CONCLUSIONS: Among potential cornea donors, a population prescree ned for identifiable HIV-1 risk factors, positive syphilis serology ap pears to be a poor marker for HIV-1 infection. The role of syphilis sc reening of potential cornea donors may need to be reevaluated.