title: Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor.
abstract: BACKGROUND
  Since 1985, donors of organs or tissues for transplantation in the United States have been screened for human immunodeficiency virus type 1 (HIV-1), and more than 60,000 organs and 1 million tissues have been transplanted. We describe a case of transmission of HIV-1 by transplantation of organs and tissues procured between the time the donor became infected and the appearance of antibodies. The donor was a 22-year-old man who died 32 hours after a gunshot wound; he had no known risk factors for HIV-1 infection and was seronegative.
  
  
  METHODS
  We reviewed the processing and distribution of all the transplanted organs and tissues, reviewed the medical histories of the donor and HIV-1-infected recipients, tested stored donor lymphocytes for HIV-1 by viral culture and the polymerase chain reaction, and tested stored serum samples from four organ recipients for HIV-1 antigen and antibody.
  
  
  RESULTS
  HIV-1 was detected in cultured lymphocytes from the donor. Of 58 tissues and organs obtained from the donor, 52 could be accounted for by the hospitals that received them. Of the 48 identified recipients, 41 were tested for HIV-1 antibody. All four recipients of organs and all three recipients of unprocessed fresh-frozen bone were infected with HIV-1. However, 34 recipients of other tissues--2 receiving corneas, 3 receiving lyophilized soft tissue, 25 receiving ethanol-treated bone, 3 receiving dura mater treated with gamma radiation, and 1 receiving marrow-evacuated, fresh-frozen bone--tested negative for HIV-1 antibody. Despite immunosuppressive chemotherapy, HIV-1 antibody appeared between 26 and 54 days after transplantation in the three organ recipients who survived more than four weeks.
  
  
  CONCLUSIONS
  Although rare, transmission of HIV-1 by seronegative organ and tissue donors can occur. Improvements in the methods used to screen donors for HIV-1, advances in techniques of virus inactivation, prompt reporting of HIV infection in recipients, and accurate accounting of distributed allografts would help to reduce further this already exceedingly low risk.
authors.affiliation: Division of HIV/AIDS, Centers for Disease Control, Atlanta, GA 30333.
authors.forename: R J
authors.initials: RJ
authors.lastname: Simonds
authors.forename: S D
authors.initials: SD
authors.lastname: Holmberg
authors.forename: R L
authors.initials: RL
authors.lastname: Hurwitz
authors.forename: T R
authors.initials: TR
authors.lastname: Coleman
authors.forename: S
authors.initials: S
authors.lastname: Bottenfield
authors.forename: L J
authors.initials: LJ
authors.lastname: Conley
authors.forename: S H
authors.initials: SH
authors.lastname: Kohlenberg
authors.forename: K G
authors.initials: KG
authors.lastname: Castro
authors.forename: B A
authors.initials: BA
authors.lastname: Dahan
authors.forename: C A
authors.initials: CA
authors.lastname: Schable
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000635:transmission*; D000328:Adult; D016025:Bone Transplantation / Q000009:adverse effects; D002478:Cells, Cultured; D016039:Corneal Transplantation / Q000009:adverse effects; D015483:HIV Antibodies / Q000032:analysis; D006679:HIV Seropositivity; D015497:HIV-1 / Q000302:isolation & purification; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008214:Lymphocytes / Q000382:microbiology; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects*; D014015:Tissue Banks / Q000592:standards*; D014019:Tissue Donors; D014481:United States
chemical_list: D015483:HIV Antibodies