R. Malhotra et Daf. Morgan, p24 antigen screening to reduce the risk of HIV transmission by seronegative bone allograft donors, NAT MED J I, 13(4), 2000, pp. 190-192
Background. During the lan decade, more than 2000 bone allografts harvested
from 888 donors and processed by the Queensland Bone Bank have been transp
lanted in over 1500 patients in Australia and New Zealand, A strict protoco
l to eliminate HIV transmission by fresh frozen allografts is followed; and
not a single case of HIV transmission has been reported.
Methods. All donors were screened and strict donor exclusion criteria were
used. All donor blood samples were subjected to double testing including an
tibody to HIV-1, HIV-2 and HTLV-1 and p24 antigen. The allografts negative
for these tests were subjected to processing, including removal of extraneo
us tissue, pulsatile lavage to remove marrow elements, and immersion in 97%
alcohol for 20 minutes. Allografts were subjected to 25 cGy irradiation be
fore transplantation.
Results. Allografts were retrieved from a total of 950 donors and 51 were d
iscarded after screening for contamination by organisms other than HIV-1. E
leven donors negative for HIV-1 antibodies tested positive for p24 antigen
and were discarded, Allografts from donors testing negative for both the te
sts (n=888) were irradiated and used for transplantation.
Conclusions. Routine p24 antigen testing and irradiation of allograft shoul
d be mandatory for bone banks, especially those freezing fresh allografts,
p24 antigen testing is inexpensive, rapid and easy. Certain guidelines must
be followed to avoid misleading results of p24 testing.