HIV infection in human bone.

Bone transplantation is often used for the reconstruction of defects. The best results are achieved with autogenous grafts because they induce no immunological reaction, but allogeneic grafts from bone banks are frequently used to provide an adequate volume of bone (Cookson et al 1988). In Germany, about 470 departments using such banks perform about 71 000 autogenous and about 25 000 allogeneic bone grafts each year (Jerosch et al 1990). In addition some 4000 bone marrow transplantations are performed each year ; a total of 30 000 to date (Bortin and Rimm 1989; Ehninger, Schuler and Schaefer 1991). Allografting increases the risk of bacterial and viral contamination, particularly with hepatitis virus and human immunodeficiency virus (HIV). It has been shown by co-cultivation that HIV-l is present not only in lymphocytes but also in bone from HIV-1-infected individuals (Buck et al 1990; Merz et al 1991). In 1988 it was first reported that HIV-1 transmission could occur by bone transplantation (Centers for Disease Control 1988). With the ever-increasing number of bone grafts performed world-wide there is an increasing risk of HIV1-infection if precautions are not taken to prevent viral transmission (Bortin and Rimm 1989; Buck, Malinin and Brown 1989 ; Jerosch et al 1990 ; Ehninger et al 1991). Guidelines for bone banks have been proposed to minimise the risk of viral infection (Hackenbroch 1990). Provided that a combination of rigorous donor selection, histopathological analysis and laboratory testing is