Detection of Hhuman Immunodeficiency Virus in Corpsic Blood: New Opportunities for Optimizing Epidemiological Surveillance and Safety Systems

Aim. To determine HIV antibodies and viral load levels in cadaveric blood samples from individuals with undiagnosed HIV infection during their lifetime, and to propose measures to optimize the system of epidemiological surveillance and safety.

Materials and methods. A targeted screening of 710 cadaveric blood samples was conducted, received from the forensic medical examination bureau. Blood sampling was performed from the heart cavities or large vessels in accordance with the regulatory documents of the Russian Ministry of Health. The exact time of sample collection relative to the moment of death was not recorded, but it typically occurred within several hours after death was confirmed. The lifetime HIV status of the deceased was unknown. A total of 710 samples were analyzed; HIV was confirmed in 1.5 % of cases (n = 11). Primary detection of HIV-1/2 antibodies and p24 antigen was performed using the “MilaLab-ELISA-HIV-Ag+At” enzyme immunoassay test system. Seropositivity confirmation and antibody profile determination were performed using immune blot testing with the “MilaBlot-HIV” kit. To assess epidemiological risk in seropositive individuals, quantitative determination of HIV-1 RNA was performed using PCR (“AmpliSense HIV-MONITOR-FRT” kit). Viral load could not be determined in two samples due to hemolysis.

Results. Positive immune blot for HIV was detected in 1.5% of samples. Antibodies to gp160 and gp41 proteins were detected in 100 % of cases, to gp120, p31, and gag24 − in 91 %, to gp36 − in 27 % (3/11), to p51/66 and gag17 − in 64 % (7/11). Viral load results ranged from 48 to 390,000 copies/ ml. In the vast majority of cases (78 %), the viral load exceeded 1,000 copies/ml, indicating high risks of HIV transmission.

Conclusion. The obtained data indicate the need for validation of existing test systems for postmortem HIV diagnosis; development of an algorithm for epidemiological detection of HIV infection cases in cadaveric blood; examination of first-line contact persons; strengthening epidemiological safety measures for thanatologists and medical personnel when working with cadaveric material.

1. Leshchinskaya N.P., Smol'skaya T.T. Posmertnoe opredelenie antitela k virusu immunodeficita cheloveka. Klinicheskaya laboratornaya diagnostika. 1993;(3):47–50. (In Russ.).

2. Heim A., Wagner D., Rothämel T., Hartmann U., Flik J., Verhagen W. Evaluation of serological screening of cadaveric sera for donor selection for cornea transplantation. J. Med. Virol. 1999;58(3):291– 295. https://doi.org/10.1002/(sici)1096-9071(199907)58:3<291::aidjmv16>3.0.co;2

3. Pepose JS, Pardo F, Kessler JA, Kline R, Donegan E, Quinn TC. Screening cornea donors for antibodies against human immunodeficiency virus. Efficacy of ELISA testing of cadaveric sera and aqueous humor. Ophthalmology. 1987;94(2):95–100. https://doi.org/10.1016/s0161-6420(87)33489-x

4. Duma S.M., Rudd R.W., Crandall J.R. A protocol system for testing biohazardous materials in an impact biomechanics research facility. Am. Ind. Hyg. Assoc. J. 1999;60(5):629–634. https://doi.org/10.1080/00028899908984483

5. Borchi B., Ambu S., Bresci S., Zanazzi M., Salvadori M., Leoncini F. Case report: HIV infection from a kidney transplant. Transplant. Proc. 2010;42(6):226–229. https://doi.org/10.1016/j.transproceed.2010.05.026

6. Edler C., Wulff B., Schröder A.S., Wilkemeyer I., Polywka S., Meyer T., et al. A prospective time-course study on serological testing for human immunodeficiency virus, hepatitis B virus and hepatitis C virus with blood samples taken up to 48 h after death. J. Med. Microbiol. 2011;60(Pt 7):920–926. https://doi.org/10.1099/jmm.0.027763-0

7. Baleriola C., Johal H., Robertson P., Jacka B., Whybin R., Taylor P., et al. Infectious disease screening of blood specimens collected postmortem provides comparable results to pre-mortem specimens. Cell Tissue Bank. 2012;13(2):251–258. https://doi.org/10.1007/s10561-011-9252-6

8. Greenwald M.A., Kerby S., Francis K., Noller A.C., Gormley W.T., Biswas R., et al. Detection of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus in postmortem blood specimens using infectious disease assays licensed for cadaveric donor screening. Transpl. Infect. Dis. 2018;20(1). https://doi.org/10.1111/tid.12825

9. Ribeiro V.S.T., Raboni S.M., Suss P.H., Cieslinski J., Kraft L., Dos Santos J.S., et al. Detection and quantification of human immunodeficiency virus and hepatitis C virus in cadaveric tissue donors using different molecular tests. J. Clin. Virol. 2019;121:104203. https://doi.org/10.1016/j.jcv.2019.104203

10. Kok C.C., Ramachandran V., Egilmezer E., Ray S., Walker G.J., Rawlinson W.D. Serological testing for infectious diseases markers of donor specimens from 24 h after death show no significant change in outcomes from other specimens. Cell. Tissue Bank. 2020;21(2):171–179. https://doi.org/10.1007/s10561-020-09810-x

11. Kohmer N., Kortenbusch M., Berger A., Rühl C., Ciesek S., Salla S., et al. Suitability of Different Diagnostic Platforms for Virological Testing of Blood Samples from Cornea Donors. Transfus. Med. Hemother. 2022;49(6):379–387. https://doi.org/10.1159/000524250

12. Stanworth S.J., Warwick R.M., Ferguson M., Barbara J.A. A UK survey of virological testing of cadaver tissue donors. Microbiology Working Group of the NIBSC steering group on Tissue/Cell Banking and Engineering. Vox Sang. 2000;79(4):227–230. https://doi.org/10.1159/000056735

13. Gubbe K., Scharnagl Y., Grosch S., Tonn T., Schmidt M., Hourfar K.M., et al. Validation of Virus NAT for HIV, HCV, HBV and HAV Using Post-Mortal Blood Samples. Transfus. Med. Hemother. 2012;39(6):381–385. https://doi.org/10.1159/000345319

14. Schmack I., Ballikaya S., Erber B., Voehringer I., Burkhardt U., Auffarth G.U., et al. Validation of Spiked Postmortem Blood Samples from Cornea Donors on the Abbott ARCHITECT and m2000 Systems for Viral Infections. Transfus. Med. Hemother. 2020;47(3):236–242. https://doi.org/10.1159/000502866

15. Nyamweya S., Hegedus A., Jaye A., Rowland-Jones S., Flanagan K.L., Macallan D.C. Comparing HIV-1 and HIV-2 infection: Lessons for viral immunopathogenesis. Rev. Med. Virol. 2013;23(4):221–240. https://doi.org/10.1002/rmv.1739

16. Azevedo-Pereira J.M., Santos-Costa Q. HIV Interaction With Human Host: HIV-2 As a Model of a Less Virulent Infection. AIDS Rev. 2016;18(1):44–53. PMID: 26936760

17. Visseaux B., Le Hingrat Q., Damond F., Charpentier C., Descamps D. Physiopathologie de l’infection par le VIH-2 [Physiopathology of HIV-2 infection]. Virologie (Montrouge). 2019;23(5):277–291. https://doi.org/10.1684/vir.2019.0789

18. Ryazanova G.A., Koksin V.P., Hamzina R.V. «Svobodnye» I «Svyazannye» antitela k strukturnym belkam VICh-1 v rannij period zabolevaniya. Medicinskaya immunologiya. 2005;7(1):73–76. https://doi.org/10.15789/1563-0625-2005-1-73-76)