HDCN Article Review/Hyperlink

Farzadegan H, Ford D, Malan M, Masters B, Scheel PJ Jr

HIV-1 survival kinetics in peritoneal dialysis effluent

Kidney Int (Nov) 50:1659-1662 1996

It is well known that HIV may survive in PD effluent, and universal precautions are required when handling PD solutions (i.e., when doing PET tests, etc.). However, there is little information on the survivability of HIV in such solutions, and on the efficacy of various disinfectant agents.

One hundred TCID50 units of HIV-1 Mn, source unspecified, were added to PD effluent (volume unspecified) from uninfected patients. The effluents were incubated at room temperature, and aliquots were removed at various times up to 14 days, and assayed for P24 antiger by ELISA. In another experiment, tubing seeded with HIV-1 containing PDE and incubated for 1 hours was rinsed with bleach, and then flushed with culture medium, the latter periodically assayed for P24. In still other studies, HIV added to PDE was exposed to various dilutions of 50% Amukin or 10% bleach. The solution was then centrifuged, the disinfectants thereby removed, and the resuspension cultured for P24 antigen. PD effluent supported growth of HIV for up to 7 days, and in tubing for up to 48 hours. 1:2048 final dilutions of bleach, or 1:2048 dilution of 50% Amukin were not effective as disinfectants, although 1:512 and higher dilutions were effective.

Comment: The study underlines the need to use universal precautions in handling PD fluid (so what else is new; what about the hepatitis C, G, etc.?). One shortcoming of the present paper is, that HIV virus is added to PD effluent in an artificial manner which does not replicate the clinical situation. For example, presence of virus in lymphocytes and monocytes/macrophages may increase infectivity. In fact, I never understood why nasal secretions were considered non-infectious for HIV, when so many persons have sinusitis with secretions that often contain large numbers of leukocytes. So viability of HIV in effluent from patients who are natively infected might be even higher than in the present study. (John T. Daugirdas, M.D., University of Illinois at Chicago)