Human T-cell leukemia/lymphotropic virus type III in the conjunctival epithelium of a patient with AIDS

Infectious Disease Transmission through Cell, Tissue, and Organ Transplantation: Reducing the Risk through Donor Selection

The incidence of cell transplant-transmitted infection is unknown and can only be inferred from prospective studies–that have not yet been performed and reported. The possibility of donor-to-recipient disease transmission through cell transplant therapy can be considered by reviewing the risk associated with other transplanted tissues and organs. Viral, bacterial, and fungal infections have been transmitted via transplantation of organs, tissue allografts such as bone, skin, cornea, and heart valves, and cells such as islets, hematopoietic stem cells, and semen. Several types of protozoan and worm parasites have been transferred via organ transplants. Bone allografts have transmitted hepatitis, tuberculosis, and human immunodeficiency virus (HIV-1). Corneas have transmitted rabies, Creutzfeldt-Jakob disease (CJD), hepatitis B (HBV), cytomegalovirus (CMV), herpes simplex virus (HSV), bacteria, and fungi. Heart valves have been implicated in transmitting tuberculosis and hepatitis B. HIV-1 and CMV seroconversion has been reported in patients receiving skin from seropositive donors. CJD has been transmitted by dura and pericardium transplants. Over the past several years, improvements in donor screening criteria, such as excluding potential donors with infection and those with behaviors risky for HIV-1 and hepatitis infection, and introduction of new donor blood tests have greatly reduced the risk of HIV-1 and hepatitis and may have nearly eliminated the risk of tuberculosis and CJD. Prior to use, many tissues are exposed to antibiotics, disinfectants, and sterilants, which further reduce or remove the risk of transmitted disease. Because organs, cells, and some tissue grafts cannot be subjected to sterilization steps, the risk of infectious disease transmission remains and thorough donor screening and testing is especially important.

A distinct cytokines profile in tear film of dry eye disease (DED) patients with HIV infection

PURPOSE

To investigate the tear cytokine profile in HIV patients with dry eye disease (DED) and study the association between the severity of ocular inflammatory complications and tear cytokines levels. We postulate that HIV-mediated inflammation may be the underlying pathogenic mechanism for HIV-associated DED.

METHODS

The current prospective case-control study compared tear film cytokine profiles in DED patients with HIV infection (n=34) and age/gender-matched DED patients without HIV infection [controls (n=32)]. Participants were recruited from tertiary referral eye care centre and communicable disease clinics, Singapore. Ocular surface health was documented using tear film, Schirmer's test, corneal staining, and conjunctival injection measurements. Tear samples were collected using Schirmer's strips and analysed for the levels of 41 cytokines using Luminex bead assay. Logistic regression models were performed to determine correlation and significance.

RESULTS

Among the 41 cytokines analysed, statistically significant differences were observed in the mean values of epithelial growth factor (EGF), growth related oncogene (GRO) and interferon gamma-induced protein 10 (IP-10). EGF and IP-10 levels were higher and GRO levels were lower in the tears of DED patients with HIV infection compared to DED patients without HIV infection. No significant association was found between varying levels of ocular surface parameters and cytokine concentrations in HIV patients with DED (p>0.05).

CONCLUSIONS

EGF and IP-10 were significantly elevated and GRO levels were lower in the tear profile of HIV patients with DED compared to immunocompetent patients with DED. This study suggests a novel cytokine driven paradigm for ocular inflammatory complications of HIV infection. Additional studies in large organised cohorts can validate the results.

Extrachromosomal DNA length and antibiograms of Staphylococcus aureus and Pseudomonas aeruginosa isolated from tears of HIV/AIDS patients after curing with sodium dodecyl sulphate

Staphylococcus aureus and Pseudomonas aeruginosa strains were isolated from eye swab samples randomly obtained from 100 seropositive HIV/AIDS patients who reported to various anti-retroviral treatment clinics at the University of Benin Teaching Hospital and Central Hospital both based in Benin City, Nigeria. Invitro antibiotic sensitivity patterns of strains before curing were determined by the Kirby-Bauer disc diffusion technique. Resistance plasmid DNA of multidrug resistant strains was cured with 0.1% sodium dodecyl sulphate and cured strains were again subjected to in vitro antibiotic sensitivity testing. EcoRI and Hind III restriction endonuclease enzymes were used to make cuts on extracted plasmid DNA whose length sizes were then determined. A total of 36 (36.0%) strains made up of 27 (75.0%) Staphylococcus. aureus and 9 (25.0%) Pseudomonas aeruginosa were isolated of which 7 (19.4%) strains showed multidrug resistance to ciprofloxacin, pefloxacin, ofloxacine, gentamycin, tetracycline, ampicillin, chloramphenicol, nitrofurantoin and erythromycin. All seven multidrug resistant strains before curing, recorded 85.7%, 42.9%, 14.3% and 14.3% sensitivity in that decreasing order to ciprofloxacin, pefloxacin, ofloxacin and gentamycin respectively. There was 0.0% sensitivity each to tetracycline and ampicillin. After curing, there was enhanced sensitivity of 100.0%, 85.7%, 28.6% and 71.4% respectively. There was also 28.6% and 57.1% improved sensitivity to tetracycline and ampicillin after curing. Before curing, there was 76.2% average resistance to all used antibiotics and this reduced to 47.6% after curing Staph. aureus plasmid DNA. In the case of Pseudomonas aeruginosa, there was an average resistance of 76.3% before curing which fell to 42.5% after curing. EcoRI restriction enzyme gave the plasmid DNA length of Staphylococcus aureus strain 04 as 4.0Kb and this size depended upon the distance between recognition sites. Isolation of 36 (36.0%) strains of both isolates from 100 eye swabs shows the danger these organisms portend to all categories of opticians. The cheapness and high sensitivity of gentamycin justifies its use as eye drops for treatment of some eye infections. Curing of plasmid DNA is an indication that if SDS is administered to the organisms in sublethal doses, it can lead to the elimination of plasmid DNA without adverse effect on the genomic DNA of the bacterial strains.

Anterior Segment and External Ocular Disorders Associated with Human Immunodeficiency Virus Disease

The eye is a common site for complications of human immunodeficiency virus (HIV) infection. Although cytomegalovirus retinitis remains the most prevalent of the blinding ocular disorders that can occur in individuals with the acquired immunodeficiency syndrome (AIDS), several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae. Some of these entities, such as Kaposi sarcoma, were well described, but uncommon, before the HIV epidemic. Others, like microsporidial keratoconjunctivitis, have presentations that differ between affected individuals with HIV disease and those from the general population who are immunocompetent. The treatment of many of these diseases is challenging because of host immunodeficiency. Survival after the diagnosis of AIDS has increased among individuals with HIV disease because of more effective antiretroviral therapies and improved prophylaxis against, and treatment of, opportunistic infections. This longer survival may lead to an increased prevalence of anterior segment and external ocular disorders. In addition, the evaluation and management of disorders such as blepharitis and dry eye, which were previously overshadowed by more severe, blinding disorders, may demand increased attention, as the general health of this population improves. Not all individuals infected with HIV receive potent antiretroviral therapy, however, because of socioeconomic or other factors, and others will be intolerant of these drugs or experience drug failure. Ophthalmologists must, therefore, still be aware of the ocular findings that develop in the setting of severe immunosuppression. This article reviews the spectrum of HIV-associated anterior segment and external ocular disorders, with recommendations for their evaluation and management.

Human immunodeficiency virus type 1 can infect human retinal pigment epithelial cells in culture and alter the ability of the cells to phagocytose rod outer segment membranes

Human immunodeficiency virus type 1 (HIV-1) has been found in the vitreous of persons with AIDS. Here we investigated the susceptibility of human retinal pigment epithelial (RPE) cells to HIV-1 infection in culture and the effects of HIV-1 on the phagocytic function of the RPE. We found that 10 of 11 populations of RPE cells isolated from different fetal or adult eyes were susceptible to low-level replication of HIV-1/NL4-3 as determined by the detection of viral DNA and spliced viral RNA encoding envelope. HIV-1 infection was not inhibited by recombinant soluble CD4, suggesting that CD4 is not required for virus entry into RPE cells. RPE cells fused with target cells constitutively expressing HIV-1 envelope glycoproteins, indicating that HIV-1 enters cells by receptor-mediated fusion. Exposure to HIV-1 or recombinant gp120 caused a two- to four-fold increase in the binding and uptake of isolated rod outer segments by RPE cells. These findings introduce a new cell target of HIV-1 replication in the eye and indicate that RPE cells function aberrantly when exposed to HIV-1 or its envelope glycoprotein.

Comparison of intraocular to plasma HIV-1 viral burden in patients with cytomegalovirus retinitis

PURPOSE

To determine the relationship between plasma and intraocular human immunodeficiency virus-1 (HIV-1) viral loads in 12 consecutive patients undergoing ganciclovir implant surgery for cytomegalovirus (CMV) retinitis.

METHODS

Aqueous and vitreous specimens were assayed for HIV-1 viral load by polymerase chain reaction analysis (Roche Amplicor HIV Monitor; Roche Diagnostics Systems, Inc, Branchburg, New Jersey).

RESULTS

It was possible to quantitatively assay HIV-1 burden in intraocular fluids using polymerase chain reaction analysis. In general, patients with plasma viral loads less than 250,000 copies/ml had undetectable (<200 copies/ml) HIV-1 in their aqueous and vitreous.

CONCLUSIONS

It is likely that intraocular viral levels have several determinants in addition to plasma viral loads, with which they only partially correlate.

Enhancement of human immunodeficiency virus type 1 (HIV-1) infection via increased membrane fluidity by a cationic polymer

Cationic polymers are known to have potent activity against bacteria, but their effects on viral activity have been little studied. We investigated the effect of one such polymer, polyethyleneimine (PEI), on HIV-1 infection. Although virus-cell binding was significantly inhibited by PEI, HIV-1 infection in human T-cell lines such as MT-4 and MOLT-4 was accelerated conversely when the drug treatment was carried out, after the virus had attached to the cells or PEI was simultaneously added to the virus and cell culture system. This paradoxical effect of PEI on HIV-1 infection was examined using HIV-1 chronically infected cells (MOLT-4/HIV-1). Dissociation of the glycoprotein gp120 (as revealed by exposure of transmembrane protein gp41) from MOLT-4/HIV-1 cells and the resultant fusion of these cells was shown to be induced by the addition of PEI. Accordingly, it was suggested that the binding inhibition of HIV-1 to CD4-positive cells by PEI was due to the shedding of gp120 from HIV-1 particles, and this PEI rather promoted membrane fusion between the virus and cells leading to the enhancement of HIV-1 infection. Similarly, dissociation of gp120 from MOLT-4/HIV-1 was also induced by sCD4. The effect of these reagents on changes in membrane fluidity was evaluated by polarization (p) measurements, and it was observed that the acceleration of membrane fluidity occurred only in the PEI system. Therefore, it is likely that PEI accelerates HIV-1 infection by facilitating virus entry into the host cells through an increase in membrane fluidity.

Uveitis associated with human immunodeficiency virus infection

PURPOSE

To report uveitis associated with human immunodeficiency virus (HIV) infection and to suggest guidelines for treatment.

METHODS

Six HIV-seropositive patients (10 eyes) with anterior or posterior uveitis or both were evaluated. After ineffective prolonged treatment with systemic and topical corticosteroids, specific systemic antiretroviral therapy with zidovudine was initiated in all patients. Aqueous humor was cultured in three eyes of three patients, and vitreous humor was cultured in one eye of one patient.

RESULTS

In all 10 eyes of six patients, there was resolution of inflammation in 10 to 42 days after commencement of treatment with zidovudine (600 to 800 mg/day), despite no or minimal response to corticosteroids. Cultures of aqueous humor from three eyes of three patients and culture of vitreous humor from one eye of one patient were positive for HIV; no other organism was isolated. Systemic evaluation disclosed no other identifiable cause for the uveitis in any patient.

CONCLUSIONS

Infection with HIV appears to be a cause of uveitis. A trial of zidovudine may be warranted in HIV-seropositive patients with uveitis that is poorly responsive to corticosteroid treatment when no other cause is identified. The efficacy of other retroviral agents was not determined.

Elevation of laser flare photometry in patients with cytomegalovirus retinitis and AIDS

PURPOSE

To investigate an alteration of the blood-ocular barriers by laser flare photometry in patients with acquired immunodeficiency syndrome (AIDS) diagnosed with cytomegalovirus retinitis.

METHODS

Serial laser flare photometry measurements from 31 eyes of 31 patients with AIDS and newly diagnosed cytomegalovirus retinitis were compared with measurements from 31 control patients with AIDS but without documented eye disease. Location and extent of retinitis, presence of visual symptoms, and CD4 lymphocyte counts were also compared with laser flare photometry readings.

RESULTS

Laser flare readings (mean +/- SE) were significantly higher in eyes with (13.0 +/- 1.5 photon counts per msec) than without cytomegalovirus retinitis (4.9 +/- 0.3 photon counts per msec) (P < .001). Lesions within the arcade vessels resulted in significantly higher laser flare photometry readings (17.3 +/- 2.5 photon counts per msec) compared with peripheral retinitis (9.8 +/- 1.5 photon counts per msec) (P = .01). A significant correlation was found between area of involvement of peripheral retinitis and laser flare photometry readings (P = .008). Readings in patients without cytomegalovirus retinitis increased significantly 10 months after the first measurement (9.5 +/- 1.9 photon counts per msec) (P = .04). Readings in patients with cytomegalovirus remained elevated 3 months after successful treatment of retinitis (12.3 +/- 2.3 photon counts per msec) (P = .6).

CONCLUSIONS

Laser flare photometry readings are significantly elevated in eyes with cytomegalovirus retinitis, suggesting a breakdown of the blood-ocular barriers. Increasing laser flare photometry readings over time in patients without known ocular disease suggests that HIV infection may cause progressive breakdown of the blood-ocular barrier.

Screening potential corneal donors for HIV-1 by polymerase chain reaction and a colorimetric microwell hybridization assay

PURPOSE

Current screening of potential corneal donors for human immunodeficiency virus type 1 (HIV-1) involves serologic detection of antibodies to the virus. However, this approach cannot detect infection during the seronegative window period of the disease. We therefore evaluated the polymerase chain reaction (PCR) assay for viral nucleic acid as a possible alternative to screening cadaveric blood for HIV-1.

METHODS

Blood specimens from cadavers diagnosed at autopsy with acquired immunodeficiency syndrome (AIDS) (n = 21), at high risk for HIV-1 infection (n = 47), and at no known risk (n = 350) were screened by PCR for HIV-1 proviral DNA and human leukocyte antigen (HLA)-DQ alpha sequences, and for HIV antibodies.

RESULTS

All AIDS group samples were seropositive; of these, 18 (86%) and 20 (95%) of 21 were positive for HIV by PCR of proteinase K- and Chelex-extracted pellets, respectively. The seropositive samples negative by PCR testing were shown to inhibit PCR amplification. Nine (19%) of 47 high-risk specimens were HIV-positive. The no-known-risk group yielded negative results. The overall sensitivities for PCR in the proteinase K- and Chelex-treated groups were 90% and 97%, respectively, compared with Western blot reactivity. If PCR-inhibitory samples and HLA-DQ alpha-negative samples had been eliminated, sensitivity would have been 100%. Specificity was 100% for each group.

CONCLUSIONS

Screening cadaveric blood by PCR may be feasible, but further refinement of the assay and blood specimen collection practices will be necessary for it to become routine. Future studies should focus on optimizing specimen procurement and preparation to reduce or eliminate specimens that inhibit PCR.

Morphological and ultrastructural changes induced in corneal epithelial cells by HIV-1 and HHV-6 in vitro

PURPOSE

The purpose of this study was to determine whether HIV-1 and HHV-6 are capable of infecting and inducing morphological and ultrastructural changes in corneal epithelial cells in vitro.

METHODS

Primary and transformed corneal epithelial cell cultures were infected with HIV-1 or HHV-6 in vitro and analyzed for the presence or absence of viral antigens, DNA sequences, viral particles and inclusions.

RESULTS

HIV-1 antigens were detected in 8% of the HIV-1 infected cells and early HHV-6 antigens were present in 12% of the HHV-6 infected cells. The presence of viral DNA sequences in the cultures confirmed these findings. Cells infected with HIV-1 morphologically were not different from uninfected cells, whereas the morphology of HHV-6 infected cells was very similar to cells infected with other human herpesviruses. Cytoplasmic tubuloreticular inclusions were detectable in corneal epithelia cells infected with HIV-1 and intact viral particles were visible only in PBMC used to recover HIV-1 from these cultures. Viral inclusions were also observed in corneal epithelial cells infected with HHV-6.

CONCLUSION

These data indicate that HIV-1 and HHV-6 are capable of infecting corneal epithelial cells in vitro, but the viruses are not entering these cells via CD4 or galC receptors. This basic information is important in determining the pathogenic mechanism(s) involved in the development of AIDS-associated corneal disorders.

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 syphilis serology as a surrogate marker for human immunodeficiency virus-1 (HIV-1) infection. We examined the correlation between positive syphilis 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 HIV-1 between Feb. 1 and July 30, 1992. We subsequently used the polymerase 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 within 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 of 31 donors who originally tested seropositive for syphilis by nontreponemal screening tests (Venereal Disease Research Laboratory or rapid plasma reagin tests) proved seronegative for syphilis when further tested with a treponemal test (FTA-ABS or microhemagglutination-Treponema pallidum), suggesting a high (38.7%) false-positive rate for the syphilis screening tests. Additionally, all 21 rapid plasma reagin and fluorescent-treponemal antibody-positive, HIV-1 ELISA-negative donors further tested were also negative for HIV-1 by the polymerase chain reaction.

CONCLUSIONS

Among potential cornea donors, a population prescreened for identifiable HIV-1 risk factors, positive syphilis serology appears to be a poor marker for HIV-1 infection. The role of syphilis screening of potential cornea donors may need to be reevaluated.

Screening corneas for human immunodeficiency virus type 1 proviral DNA by polymerase chain reaction

PURPOSE

We evaluated the sensitivity of the polymerase chain reaction as a technique to directly screen potential donor corneas for human immunodeficiency virus type 1 (HIV-1) proviral DNA.

METHODS

DNA from the central 8.0-mm cornea, limbal cornea, aqueous humor, and retina from 22 eyes of 11 cadavers seropositive for HIV was extracted and amplified by polymerase chain reaction using primers specific for the gag and env regions of the HIV-1 genome. The identity of amplification products was confirmed by Southern blot hybridization.

RESULTS

Viral DNA was detected in four (18.2%) of 22 central corneas, one (4.5%) of 22 limbal corneas, one (6.3%) of 16 aqueous humor samples, and seven (31.8%) of 22 retinas. No correlation was noted between the presence of HIV-1 proviral DNA in samples from the central cornea and from the other tissues tested from the same eye.

CONCLUSIONS

Within the limits of our assay, processing and analysis of limbal cornea, aqueous humor, and retina by polymerase chain reaction may not reliably ascertain the presence of HIV-1 in the central, transplantable cornea.

Detection of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in donor eyes using polymerase chain reaction

Detection of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) in donor eyes was performed. DNAs were extracted from the uvea, and they were amplified using the polymerase chain reaction (PCR). Amplified viral DNAs were detected with liquid hybridisation and chemiluminescent assay in which no radioactive materials were used. This method was shown to have a sensitivity limit of fewer than 10 copies of HIV, making it much more sensitive than the current techniques employed in eye banks. The method was applied to 120 donor eyes, including four from donors seropositive for HBV. The HBV gene was detected in one case in which the donor's blood had not been tested for HBV. HIV and HCV genes were not detected in any of the samples. The assay could be an effective screening test for the detection of these viruses in eye bank eyes.

Detection of HIV in human vitreous

Assay of human vitreous specimens obtained postmortem for HIV antibodies, or HIV p24 antigen, is reported to be a reliable technique to demonstrate HIV infection in possible cornea donors from whom serum could not be obtained. We tested three vitreous samples obtained during vitrectomy from two HIV-positive patients. One patient exhibited the clinical AIDS syndrome. HIV antigen and antibody tests were negative in all specimens. HIV proviral DNA was detected by PCR only in the vitreous of the patient with AIDS. Therefore, testing only vitreous samples is insufficient to exclude HIV infection in potential cornea donors.

Spontaneous ulcerative keratitis in immunocompromised patients

We studied the occurrence of ulcerative keratitis in five eyes of four patients who were examined at the University of Maryland Hospital ophthalmology clinic over a 12-month period. All were young women who were intravenous drug abusers, with no known predisposing factors for ulcerative keratitis. Two patients had acquired immunodeficiency syndrome (AIDS), one was human immunodeficiency virus (HIV)-positive, and the fourth refused HIV testing. One had a corneoscleral limbus to corneoscleral limbus keratitis; three had inferiorly located corneal ulcers (bilateral in one patient with AIDS). Corneal cultures disclosed Capnocytophaga species in the corneoscleral limbus to corneoscleral limbus keratitis. The remaining ulcers were polymicrobial; cultures of three grew Candida albicans, cultures of two grew alpha-hemolytic streptococci, cultures of two grew Staphylococcus aureus, and culture of one grew Pseudomonas aeruginosa. Treatment with topical fortified antibiotics and antifungal agents resulted in complete healing in all four inferiorly located ulcers. The corneal ulcer became perforated and the eye was eviscerated. Histopathologic analysis of the eviscerated specimen disclosed acute keratitis with necrosis and no microorganisms.

Ocular tissue involvement in HIV infection: immunological and pathological aspects

The CNS afflictions in AIDS are myriad and suggest a tropism of HIV to neural tissue. Ocular involvement is a frequent manifestation of the HIV infection, resulting in a high incidence of blindness within this patient population. Ocular lesions include cotton wool spots, presumably from HIV-induced microvasculopathy, retinal hemorrhage in cytomegalovirus retinitis and conjunctival Kaposi's sarcoma. These manifestations have been noted in up to 71% of AIDS patients. In fact, ocular disease is often the presenting symptom in an HIV-infected individual. Despite the high incidence of ocular involvement in AIDS patients, the etiology and pathogenesis of these manifestations are not well understood. The immunosuppressive action of HIV is the most likely primary cause for the development of ocular complications in AIDS. Here we review some of the important immunological and pathological features of AIDS affliction in the eye.

New developments in serologic screening of corneal donors for HIV-1 and hepatitis B virus infections

PURPOSE

The authors evaluated different methods to serologically screen potential cadaveric corneal donors for human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV) infections.

METHODS

Three commercially available enzyme-linked immunosorbent assays (ELISAs) for antibodies against HIV-1, a supplemental ELISA test for HIV antigen, and a radioimmunoassay and two ELISAs for hepatitis B surface antigen were compared using serum from cadavers with acquired immune deficiency syndrome (AIDS), cadavers with high risk factors for HIV infection, and cadavers with no known risk of HIV infection, along with respective confirmatory testing.

RESULTS

The ELISA tests for HIV antibodies from Abbott Laboratories, Electro-nucleonics, and Organon-Teknika showed sensitivities of 94.3%, 94.3%, and 97.1%, respectively, compared with the autopsy diagnosis of AIDS in 35 cadavers. The sensitivities of the HIV-1 antibody ELISAs ranged between 73% and 87% compared with positive Western blots in testing 118 sera from cadavers at high risk of HIV-infection, but not manifesting AIDS at the time of death. Supplemental ELISA testing for HIV-1 antigen, in an effort to close the seronegative window, failed to identify any HIV antigen-positive sera confirmed by neutralization that were not also positive for antibodies to HIV-1 by ELISA and Western blot. The ELISA for HBV surface antigen had an overall sensitivity of 92.9% and specificity of only 81.3% compared with radioimmunoassay in testing 409 sera. Monoclonal ELISAs for HIV-1 antigen and HBV surface antigen paradoxically had lower specificity than polyclonal ELISAs, with false positivity correlating with hemolysis and with increasing death to puncture time.

CONCLUSION

ELISA testing for antibodies against HIV-1 is relatively but not absolutely effective, should be accompanied by historical screening for risk factors, and does not appear to benefit from supplemental ELISA testing for HIV-1 antigen. ELISA testing for HBV surface antigen has lower specificity in screening cadaveric sera when compared with radioimmunoassay.

Virucidal efficacy of various lens cleaning and disinfecting solutions on HIV-I contaminated contact lenses

The virucidal efficacy of various commercially available contact lens care cleaning regimens on human immunodeficiency virus (HIV-1) contaminated contact lenses using either cursory or meticulous cleaning with a rubber policeman was evaluated. Levels of infectious HIV-1 remaining on individual contact lenses were determined by cultivating the lenses with target HUT-78 cells and subsequently analyzing the cultures for the production of HIV-1 p24 by antigen capture and for HIV-1 gag gene DNA content by the polymerase chain reaction. The data indicate that most of the lens care regimens tested, when coupled with meticulous rubbing, were capable of safely decontaminating the contact lenses, that is, they reduce the amount of infectious HIV-1 on the lenses by greater than a 10 log concentration (10(-10], relative to standard controls. Most tested lens care regimens, if properly followed, would virtually eliminate any chance of the lens serving as a vector for HIV.

Vitreous fluorophotometric recordings in HIV infection

Fluorophotometry was performed in 10 patients. Five of these were affected by AIDS and five ARC (AIDS Related Complex). All patients had normal fundi detectable by standard examination and by fluorescein angiography. In spite of the normal condition of the fundus, vitreous fluorophotometry readings were constantly above normal. We believe that the disturbance of the blood retinal barrier appears before any lesion detectable both clinically and by fluorangiography. It is possible that the first toxic effect of the retrovirus is at the level of the retinal vessels.

Evidence for cytomegalovirus and human immunodeficiency virus infection of the retina in AIDS

Characteristic ophthalmopathological features of retinal lesions in a patient with the acquired immunodeficiency syndrome (AIDS) are reported. In situ hybridization, immunohistochemistry and electron microscopy revealed severe unilateral cytomegalovirus (CMV) retinitis. The opposite retina which was not involved by CMV showed nonspecific signs of ischaemia in the nerve fiber layer corresponding to cotton-wool spots. Occasional cells of both retinas were positively stained by a mouse monoclonal antibody to the p24 HIV-1 antigen indicating infection of retinal cells by HIV. It is suggested that HIV may directly or indirectly damage retinal tissue and interact with opportunistic pathogens, thus leading to a variety of ocular abnormalities associated with AIDS.

Ocular manifestations of acquired immune deficiency syndrome

The ocular complications of acquired immune deficiency syndrome (AIDS) include: (1) a noninfectious microangiopathy, most often seen in the retina, consisting of cotton-wool spots with or without intraretinal hemorrhages and other microvascular abnormalities; (2) opportunistic ocular infections, primarily cytomegalovirus (CMV) retinitis; (3) conjunctival, eyelid, or orbital involvement by those neoplasms seen in patients with AIDS (i.e., Kaposi's sarcoma and lymphoma); and (4) neuro-ophthalmic lesions. In a series of 200 AIDS patients evaluated clinically, AIDS retinopathy was present in 66.5%. Sixty-four percent had cotton-wool spots, and 12% had intraretinal hemorrhages. Cytomegalovirus retinitis was diagnosed in 28% of AIDS patients. Neuro-ophthalmic lesions were found in 8% of all AIDS patients and were present in 33% of those patients with cryptococcal meningitis. Acquired immune deficiency syndrome retinopathy was present in 40% of 35 patients with the AIDS-related complex (ARC) and in 1.3% of 232 patients with asymptomatic human immunodeficiency virus (HIV) infection, evaluated photographically. These results suggest that the prevalence of AIDS retinopathy increases with increasing severity of HIV infection, and that CMV retinitis presents a significant vision-threatening problem in AIDS patients.

Pathology of brain and eye in the acquired immune deficiency syndrome (AIDS). A comparison of lesions in a consecutive autopsy material

During the years 1984-1987, a consecutive Danish autopsy material of 43 AIDS cases was analysed in order to investigate a possible coincidence of pathological changes in brain and eye. In the brain, nodular gliosis/encephalitis was most frequent, followed by cytomegalovirus infection, which occurred twice as frequently as toxoplasmic infection and four times as frequently as fungal infection. In the eye, cytomegalovirus infection was most frequent and the only opportunistic infection, followed by retinal gliosis and cytoid body lesion. Malignant lymphoma was present in the brain in three patients, and in the choroid in two of these. In 11 patients, no changes of the brain were found. In eight of these the eye was also without pathological findings, while three had minor changes. In 22 patients the eye was normal, but in only eight of these was the brain without changes. Eight had nodular gliosis, and four a specific infection, while multifocal leucoencephalopathy and unspecified abscess each occurred in one patient. Comparison of the three opportunistic infections--CMV, toxoplasmosis and mycosis--in the three-year period showed an overall decreasing frequency, attributed to better medical care. It is concluded that concomitance of identical pathological lesions in brain and eye is less frequent than was expected.

Corneal preservation

Significant advances in corneal preservation have been made over the past decade. The introduction of chondroitin sulfate-containing media for use at 4 degrees C allows storage of corneas for up to ten days prior to transplantation. Organ culture techniques have also been improved with the addition of chondroitin sulfate. There has been an increase in our understanding of preservation using McCarey-Kaufman medium. Studies have been published that compare these methods and help the clinician decide which method to use based on objective data. Also, our understanding of existing methods of evaluating endothelial viability has increased and new methods have been developed. Finally, the acquired immunodeficiency syndrome is having an increasing effect on eye-banking and the supply of donor corneas.

The identification and incidence of human immunodeficiency virus antibodies and hepatitis B virus antigens in corneal donors

Forty eye banks responded to an Eye Bank Association of America (EBAA) questionnaire concerning screening patients at risk for acquired immune deficiency syndrome (AIDS) and hepatitis B. Respondents accounted for 26% (8787 of 33,500) of the total volume of eyes donated in North America in 1986. Sixty (0.68%) of 8787 donors were found to be antibody positive for human immunodeficiency virus (HIV) and 69 (1.33%) of 5187 donors were found to be positive for hepatitis B virus (HBV). The age, cause of death, and source of tissue were also studied. The finding of seropositivity for HIV in very young and elderly donors without identified risk factors underscores the need to screen all potential cornea donors for the presence of HIV antibodies. The data on HBV lend further support to the importance of such screening procedures.

Recovery of human immunodeficiency virus from ocular tissues in patients with acquired immune deficiency syndrome

Human immunodeficiency virus (HIV) was recovered from multiple ocular tissues in three patients with acquired immune deficiency syndrome (AIDS). Consistently found in the retina, HIV was also detected in the conjunctiva, cornea, and iris. In two cases, HIV was detectable despite treatment with oral zidovudine. All three patients had bilateral cytomegalovirus (CMV) retinitis managed by intravitreal injection of ganciclovir. Culture of the retina for CMV was negative in all three cases. The finding of HIV in multiple ocular tissues is consistent with the neurotropic nature of the virus, and may explain some of the common ocular manifestations of AIDS such as AIDS retinopathy. Infection with HIV may predispose the retina to other opportunistic infections and may explain the high incidence of CMV retinitis in AIDS patients. This is the first report of HIV isolation from tissue within the eye.

Response of human immunodeficiency virus-associated uveitis to zidovudine

A patient with human immunodeficiency virus (HIV) type 1 infection developed chronic iridocyclitis and anterior vitritis that were poorly responsive to topical and systemic corticosteroid therapy. Anterior chamber paracentesis was performed and HIV was isolated from culture of aqueous humor. Subsequent treatment with oral zidovudine resulted in resolution of the iridocyclitis and vitritis and full functional recovery of the eye. This case suggests that HIV may be a cause of uveitis responsive to systemic zidovudine therapy.

Hepatitis B surface antigen in corneal donors

Using an enzyme immunoassay, we detected hepatitis B surface antigen in washings of ocular tissue from two of three corneal donors who had positive serum assays for hepatitis B surface antigen. Hepatitis B surface antigen was identified in emulsified corneal tissue from one of two donors from whom corneal tissue was available for study.

Serologic markers after the transplantation of corneas from donors infected with human immunodeficiency virus

Four corneas from two cadavers that later had positive test results on enzyme-linked immunosorbent assays and Western blot analysis for antibodies against the human immunodeficiency virus were inadvertently transplanted to recipients who were without known risk of human immunodeficiency virus infection. We performed serial studies of serologic markers of human immunodeficiency virus infection in the cornea recipients and assayed reverse transcriptase levels of their mixed lymphocyte cultures. The four cornea transplant recipients were followed up for 130, 152, 397, and 440 days, respectively, and the results on all serologic tests and reverse transcriptase assays remain negative.

Acquired immunodeficiency syndrome (AIDS)

The Acquired Immunodeficiency Syndrome (AIDS), caused by the human immunodeficiency virus (HIV), also called the human T-lymphotropic virus type III/lymphadenopathy-associated virus [HTLV-III/LAV], has affected over 23,000 people; more than half of those with the disease have died. The actual case fatality rate approaches 100%. AIDS affects all groups and classes of people, although some are at special risk. Distribution of the disease is worldwide. The illness' effects on the body are widespread; of special interest are the ophthalmologic manifestations. The eye may be infected by various viruses (cytomegalovirus, varicella-zoster virus, herpes simplex virus or HIV itself), toxoplasma gondii, candida sp, cryptococcus neoformans, M. tuberculosis, or M. avium-intracellulare. Kaposi's sarcoma may affect the eye as well. Retinal vascular abnormalities (e.g., cotton-wool spots, vasculitis) are not uncommon in AIDS. The syndrome may present with neuro-ophthalmologic manifestations. No effective treatment for the illness is currently available, although several hold promise and there is hope for an AIDS vaccine. Prevention of infection through reduction of risks appears to be the only defense against AIDS at this time.

Updating of methods for prevention of HIV transmission during ophthalmological procedures

The presence of HIV (human immunodeficiency virus) particles in the tear fluid, on the conjunctival surface or in the contact lenses of patients with chronic HIV infection has made it necessary to establish better for guide-lines for decontamination of instruments during ophthalmological procedures. The methods are now at the stage of evolution. The present paper describes the disinfection procedures used in the Helsinki University Eye Hospital and updates the present decontamination protocols.

Screening cornea donors for antibodies against human immunodeficiency virus. Efficacy of ELISA testing of cadaveric sera and aqueous humor

Coded cadaveric sera from 35 patients with acquired immunodeficiency syndrome (AIDS), from 45 cadavers at high risk of human immunodeficiency virus (HIV) infection, and from 262 cadavers without known signs or risk of AIDS were assessed using three commercially available enzyme-linked immunosorbent assays (ELISA) kits and Western blot analysis. Greater than 94% sensitivity and 99% specificity was achieved with each of the ELISA test kits using cadaveric sera. The Western blot method gave 97.1% sensitivity compared with the autopsy-proven diagnosis of AIDS. Positive results were obtained on sera from AIDS cadavers even if the time of blood draw was delayed 35 hours from death and the time of sera preparation was delayed up to 176 days. False-negative or false-positive ELISA results did not appear to correlate with hemolysis or any parameter of sera preparation. In contrast to the high sensitivity in testing sera, only 16 to 26% of aqueous humor samples from AIDS cadavers were ELISA-positive and 79% were positive by Western blot. These results indicate that three commercially available ELISA test kits are an effective means of screening cadaveric sera for antibodies to HIV, but that aqueous humor cannot be reliably substituted for cadaveric sera to screen potential cornea donors by an ELISA assay.

HTLV-III in the tears of AIDS patients

The human T-cell leukemia/lymphotropic virus type III (HTLV-III), the causative agent of the acquired immunodeficiency syndrome (AIDS), has been isolated from the tears of five AIDS patients. When combined with data from our previous study, 5 of 16 samples from patients with AIDS or AIDS-related complex (ARC) showed positive isolates for HTLV-III from the tears. Normal control tears were negative for HTLV-III. Based upon these findings, the Centers for Disease Control (CDC) has issued precautions to prevent any possible spread of the virus by this route. Although there is no evidence to suggest transmission of HTLV-III by contact with the tears, until more is known about the possible transmissibility and infectious dose of this virus, such precautions should be taken during ophthalmic examination.

Isolation of the human T-cell leukemia/lymphotropic virus type III from aqueous humor in two patients with perivasculitis of the retinal vessels

The human T-cell leukemia/lymphotropic virus type III (HTLV-III) has been isolated from aqueous humor in two patients with perivasculitis of the peripheral retinal vessels, an AIDS-related ocular manifestation. Both patients had antibodies to HTLV-III and although they presented with herpes zoster ophthalmicus, they did not present other symptoms known to be associated with HTLV-III infection. The isolation of HTLV-III from aqueous humor in these two patients with retinal perivasculitis suggests that the virus itself may play a role in the etiology of this ocular sign. The presence of infectious HTLV-III in the anterior chamber further emphasises the necessity to discard corneas from HTLV-III infected donors.