Correspondence

Postmortem Viability of Human Immunodeficiency Virus -- Implications for the Teaching of Anatomy

N Engl J Med 1994; 331:1315November 10, 1994

Article

To the Editor:

I want to draw your attention to the viability of the human immunodeficiency virus (HIV) in cadavers and the implications of the presence of live HIV during embalming procedures in anatomy departments and during the dissection of embalmed cadavers by students.

It is the policy of anatomy departments to keep the period between the death of a patient and the embalming of the body as short as possible to minimize degeneration. Recent findings indicate that HIV in a patient who died of AIDS is still infectious at the time of the body's arrival at the anatomy department (<48 hours post mortem). Infectious HIV has been reported in the pleural fluid, pericardial fluid, and blood of such patients after storage at 2 °C for up to 16.5 days post mortem.1 Viable HIV was also recovered from bone fragments, brain, bone marrow, spleen, and lymph nodes from a patient with AIDS at autopsy six days after death.2

Recently, an occupational HIV infection in a nurse who was pricked by a needle that had been used on a drug addict was reported3; at the time of the injury, the source patient was negative for anti-HIV antibodies but positive for p24 HIV antigen. This case of transmission during the “window period” of HIV infection suggests that the bodies of patients who have died of AIDS are potential carriers of infectious virus, as are other bodies arriving in departments of anatomy. Therefore, universal precautions should always be followed in embalming rooms of anatomy departments.

Despite a thorough search of the literature, we could not find data on the disinfectant properties of fluids commonly used to embalm corpses. The embalming fluid used in anatomy departments contains fixatives, disinfectants, glycerol, and salts dissolved in water. The most frequently used fixatives and disinfectants are ethanol, formalin, and phenol. In suspension tests, 25 percent ethanol and 0.5 percent formaldehyde were shown to be effective against HIV.4 However, it is not clear whether these concentrations are also effective in cadavers, for several reasons. First, in suspension tests, cell-free virus is tested, whereas in humans, HIV is also localized within cells. Second, the concentration of the components of embalming fluid decreases as they diffuse throughout the human body. Third, several classes of products including phenolic agents are partially or completely inactivated by the presence of protein4,5; this sensitivity to organic load suggests that the efficiency of the disinfectants will be much lower in cadavers than in in vitro tests.

On the other hand, the combination of fixatives and disinfectants in embalming fluid could be more effective in inactivating HIV than each agent alone. Nevertheless, the potential hazard posed by embalmed corpses to members of anatomy departments needs investigation, with particular emphasis on the length of time it takes to inactivate HIV in all parts of embalmed human bodies, including the bones (since HIV may be spread by aerosols5).

Dirk De Craemer, Ph.D.
Vrije Universiteit Brussel, B-1090 Brussels, Belgium

5 References

1. 1

   Douceron H, Deforges L, Gherardi R, Sobel A, Chariot P. Long-lasting postmortem viability of human immunodeficiency virus: a potential risk in forensic medicine practice. Forensic Sci Int 1993;60:61-66
   CrossRef | Web of Science | Medline

2. 2

   Nyberg M, Suni J, Haltia M. Isolation of human immunodeficiency virus (HIV) at autopsy one to six days postmortem. Am J Clin Pathol 1990;94:422-425
   Web of Science | Medline

3. 3

   Ippolito G, Puro V, De Carli G, Italian Study Group on Occupational Risk of HIV Infection. The risk of occupational human immunodeficiency virus infection in health care workers. Arch Intern Med 1993;153:1451-1458
   CrossRef | Web of Science | Medline

4. 4

   Sattar SA, Springthorpe VS. Survival and disinfectant inactivation of the human immunodeficiency virus: a critical review. Rev Infect Dis 1991;13:430-437
   CrossRef | Medline

5. 5

   Scully C, Samaranayake L, Martin M. HIV: answers to common questions on transmission, disinfection and antisepsis in clinical dentistry. Br Dent J 1993;175:175-179
   CrossRef | Web of Science | Medline

Citing Articles (6)

Citing Articles

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   Amy B. Reed, Chip Crafton, Joseph S. Giglia, John D. Hutto. (2009) Back to basics: Use of fresh cadavers in vascular surgery training. Surgery 146:4, 757-763
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2. 2

   Susan Salter Davidson, William H. Benjamin. (2006) Risk of infection and tracking of work-related infectious diseases in the funeral industry. American Journal of Infection Control 34:10, 655-660
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3. 3

   Mouna Lazrek, Anne Goffard, Cécile Schanen, Cyrille Karquel, Laurence Bocket, Georges Lion, Marc Devaux, Valéry Hedouin, Didier Gosset, Didier Hober. (2006) Detection of hepatitis C virus antibodies and RNA among medicolegal autopsy cases in Northern France. Diagnostic Microbiology and Infectious Disease 55:1, 55-58
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4. 4

   John C McLachlan, John Bligh, Paul Bradley, Judy Searle. (2004) Teaching anatomy without cadavers. Medical Education 38:4, 418-424
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5. 5

   Deniz Demiryrek, Alp Bayramo??lu, ?emsettin Ustaelebi. (2002) Infective agents in fixed human cadavers: A brief review and suggested guidelines. The Anatomical Record 269:4, 194-197
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6. 6

   O Cussenot. (1999) Post-mortem detection of HIV, HTLV, hepatitis C viral infections to reduce the risk of contamination during anatomical cadaver dissections. European Journal of Internal Medicine 10:4, 223-224
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