HIV-1 DETECTION BY NESTED PCR AND VIRAL CULTURE IN FRESH OR CRYOPRESERVED POSTMORTEM SKIN - POTENTIAL IMPLICATIONS FOR SKIN HANDLING AND ALLOGRAFTING

Aims-To date, the risk relating to the handling or allografting of hum an immunodeficiency virus type 1 (HIV-1) infected postmortem skin rema ins hypothetical. While blood screening for HIV antibodies is still th e key safety procedure to detect HIV infected cadavers, false negative results are a concern. Conversely, false positive results may hamper the collection of skin allografts. Accordingly, viral culture was used to clarify skin infectivity and the nested polymerase chain reaction (PCR) was used to assess the reliability of skin PCR testing. Methods Viral culture and nested PCR performed with gag and pol specific prime rs were investigated in cadaveric skin and blood from 12 HIV-1 infecte d patients. Samples were collected repeatedly between one and five day s in seven patients. In most cases, analyses were performed on triplic ate skin samples: fresh (n = 26), cryopreserved in 5% dimethylsulphoxi de (n = 21), or cryopreserved in 30% glycerol (n = 26). Results-HIV wa s isolated in two of 26 cultures of fresh skin specimens (8%), seven o f 47 cryopreserved skim specimens (15%), and eight of 26 blood specime ns (31%). The nested PCR detected HIV-1 in all skin samples (n = 73), regardless of the postmortem interval or cryopreservation. In blood, a positive signal was found in eight of 12 patients but two of them had discordant results on successive samples. Conclusions-These data sugg est that nested FCR on postmortem skin samples can detect HIV more rel iably than on blood. They also demonstrate the potential viral infecti vity of fresh or stored skin postmortem samples in HIV infected patien ts. They underscore the need for caution during the handling of skin t issue from HIV infected cadavers and confirm the potential risk relate d to accidental allografting of HIV contaminated skin.