With HIV and HCV
By Michael Smith, Senior Staff Writer, MedPage Today
Published: November 14, 2007
Reviewed by Zsofia Szep, MD; Infectious Diseases Division, University of Pennsylvania School of Medicine.
CHICAGO, Nov. 14 -- A single transplant donor has left four recipients infected with HIV, the first such case in more than 20 years, officials here said.
And, in what is apparently the first case of two viruses being transmitted by a transplant at the same time, all four recipients also were infected with hepatitis C.
The infections were not detected in the organ donor because the test used -- the Enzyme-Linked ImmunoSorbent Assay, or ELISA -- detects the antibodies to the two viruses.
But in the first weeks after infection -- 22 days for HIV and 82 for hepatitis C -- the antibody response is not strong enough to trigger a positive test.
So, if the donor had been infected only a few weeks before death, officials said, the test would have come back negative.
The transplants took place in January at the University of Chicago Medical Center, Northwestern Memorial Hospital, and Rush University Medical Center.
But it was only two weeks ago that the infections were discovered, according to Michael Millis, M.D., of the University of Chicago Hospitals.
The news was "very surprising and devastating" for the four recipients, Dr. Millis told reporters.
Public health officials in Chicago and at the CDC are trying to see whether any of the recipients have passed on either infection during the time since their transplants.
The CDC said the last case of HIV transmission because of a transplant took place in 1986, when three people in Virginia died of AIDS after receiving infected organs.
That was in the early days of the HIV/AIDS pandemic, when safeguards were less stringent than today, officials said.
A spokesman for the United Network for Organ Sharing said there have been more than 400,000 organ transplants in the U.S. since the 1986 cases without a reported case of transmission.
"We believe there's already a very small risk of transmission through the safeguards we have in place," Joel Newman told reporters.
Once the infections were discovered, stored blood from the donor was re-tested using ELISA and also came back negative for both viruses.
Blood banks use a more sensitive test for HIV -- Nucleic Acid Amplification Testing, or NAAT -- which detects the viral genetic material directly, but that test is not routinely used in transplantation.
When the donor's blood was tested using NAAT, the HIV infection was detected.
A screening questionnaire showed that the donor had engaged
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Search the Web That isn't a question but the story sure is shocking. It is hard to believe that they would miss something like that. That is a very unfortunate case; I hope those recipients will be able to still lead healthy and productive lives.
It is evident from it being the only case in the last 20 years, that it is a rare occurrence.
Also, some people on the transplant waiting list willingly accept organs that come from donors with Hepatitis C because they would rather live with Hep C than die waiting for an organ. |
