Corneal transplantation from an HIV seroconverting donor [letter]

A corneal transplant from a "window period" donor one who although infected with human immunodeficiency virus (HIV) tests seronegative may not transmit HIV. In the case reported here the donor may not have been viremic at the time of donation since both the p24 antigen test and the polymerase chain reaction (PCR) for viral ribonucleic acid (RNA) were negative. The recipient has initially tested negative for HIV antibodies. In 6 similar cases HIV was not transmitted by corneal transplant. In another 2 cases where the donor was later found to be PCR positive for virus at the time of donation HIV was also not transmitted to corneal recipients. However recipients of other tissues did seroconvert. Although it appears that corneal transplant recipients may not have that great a risk of HIV transmission from "window period" donors faster tests with greater sensitivity are necessary to identify such donors before donation. In this case the results of 5 enzyme-linked immunosorbent assays [Genelavia Mixt Biotest Recombinant Enzygnost HIV 1 + 2 Cobas (Roche) Vironostika (Organon)] the Western blot the p24 antigen (Coulter) test and 2 PCR tests (Proviral DNA and Viral RNA) are listed for comparison.