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Current Trends Recommendations for Preventing Possible Transmission of Human T-Lymphotropic Virus Type III/ Lymphadenopathy- Associated Virus from Tears

Human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV), the etiologic agent of acquired immunodeficiency syndrome (AIDS), has been found in various body fluids, including blood, semen, and saliva. Recently, scientists at the National Institutes of Health isolated the virus from the tears of an AIDS patient (1). The patient, a 33-year-old woman with a history of Pneumocystis carinii pneumonia and disseminated Mycobacterium avium-intracellulare infection, had no ocular complaints, and her eye examination was normal. Of the tear samples obtained from six other patients with AIDS or related conditions, three showed equivocal culture results, and three were culture-negative.

The following precautions are judged suitable to prevent spread of HTLV-III/LAV and other microbial pathogens that might be present in tears. They do not apply to the procedures used by individuals in caring for their own lenses, since the concern is the possible virus transmission between individuals.

  1. Health-care professionals performing eye examinations or other procedures involving contact with tears should wash their hands immediately after a procedure and between patients. Handwashing alone should be sufficient, but when practical and convenient, disposable gloves may be worn. The use of gloves is advisable when there are cuts, scratches, or dermatologic lesions on the hands. Use of other protective measures, such as masks, goggles, or gowns, is not indicated.

  2. Instruments that come into direct contact with external surfaces of the eye should be wiped clean and then disinfected by: (a) a 5- to 10-minute exposure to a fresh solution of 3% hydrogen peroxide; or (b) a fresh solution containing 5,000 parts per million (mg/L) free available chlorine--a 1/10 dilution of common household bleach (sodium hypochlorite); or (c) 70% ethanol; or (d) 70% isopropanol. The device should be thoroughly rinsed in tap water and dried before reuse.

  3. Contact lenses used in trial fittings should be disinfected between each fitting by one of the following regimens:

    1. Disinfection of trial hard lenses with a commercially available hydrogen peroxide contact lens disinfecting system currently approved for soft contact lenses. (Other hydrogen peroxide preparations may contain preservatives that could discolor the lenses.) Alternatively, most trial hard lenses can be treated with the standard heat disinfection regimen used for soft lenses (78-80 C (172-176 F) for 10 minutes). Practitioners should check with hard lens suppliers to ascertain which lenses can be safely heat-treated.

    2. Rigid gas permeable (RGP) trial fitting lenses can be disinfected using the above hydrogen peroxide disinfection system. RGP lenses may warp if they are heat-disinfected.

    3. Soft trial fitting lenses can be disinfected using the same hydrogen peroxide system. Some soft lenses have also been approved for heat disinfection. Other than hydrogen peroxide, the chemical disinfectants used in standard contact lens solutions have not yet been tested for their activity against HTLV-III/LAV. Until other disinfectants are shown to be suitable for disinfecting HTLV-III/LAV, contact lenses used in the eyes of patients suspected or known to be infected with HTLV-III/LAV are most safely handled by hydrogen peroxide disinfection.

    The above recommendations are based on data from studies conducted

at the National Institutes of Health and CDC on disinfection/inactivation of HTLV-III/LAV virus (2-4). Additional information regarding general hospital and laboratory precautions have been previously published (5-9). Reported by the U.S. Food and Drug Administration; National Institutes of Health; Centers for Disease Control.

Editorial Note

Editorial Note: All secretions and excretions of an infected person may contain lymphocytes, host cells for HTLV-III/LAV; therefore, thorough study of these fluids might be expected to sometimes yield this virus. Despite positive cultures from a variety of body fluids of infected persons, however, spread from infected persons to household contacts who have no other identifiable risks for infection has not been documented. Furthermore, there is no evidence to date that HTLV-III/LAV has been transmitted through contact with the tears of infected individuals or through medical instruments used to examine AIDS patients. References

  1. Fujikawa LS, Salahuddin SZ, Palestine AG, et al. Isolation of human T-cell leukemia/lymphotropic virus type III (HTLV-III) from the tears of a patient with acquired immunodeficiency syndrome (AIDS). Lancet (in press).

  2. Resnick L, Veren K, Salahuddin SZ, Markham PD. Personal communication.

  3. Martin LS, McDougal JS, Loskoski SL. Disinfection and inactivation of the human T lymphotropic virus type III/lymphadenopathy-associated virus. J Infect Dis 1985;152:400-3.

  4. Spire B, Barre-Sinoussi F, Montagnier L, Chermann JC. Inactivation of a new retrovirus (lymphadenopathy-associated virus) by various agents (chemical disinfectants). Lancet 1984:8408;899-901.

  5. CDC. Acquired immune deficiency syndrome (AIDS): precautions for clinical and laboratory staffs. MMWR 1982;31:577-80.

  6. CDC. Prevention of acquired immune deficiency syndrome (AIDS): report of inter-agency recommendations. MMWR 1983;32:101-4.

  7. CDC. Acquired immunodeficiency syndrome (AIDS): precautions for health-care workers and allied professionals. MMWR 1983;32:450-1.

  8. CDC. Update: prospective evaluation of health-care workers exposed via parenteral or mucous-membrane route to blood or body fluids from patients with acquired immunodeficiency syndrome. MMWR 1985;34:101-3.

  9. CDC. Hepatitis B vaccine: evidence confirming lack of AIDS transmission. MMWR 1984;33:685-7.

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