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Free Content Utility of tuberculin and anergy skin testing in predicting tuberculosis infection in human immunodeficiency virus-infected persons in Thailand

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Abstract:

SETTING: Chiang Rai, the northernmost province of Thailand, where extensive human immunodeficiency virus (HIV) transmission has resulted in a rapid increase in tuberculosis.

OBJECTIVE: To assess the utility of tuberculin and anergy skin testing to identify latent Mycobacterium tuberculosis infection in HIV-infected persons.

DESIGN: A cross-sectional study and analysis were conducted to examine reactivity to tuberculin and two control antigens (mumps and candida) in HIV-negative and HIV-positive blood donors and female sex workers.

RESULTS: HIV-positive persons had markedly decreased tuberculin reactivity; 14%, 19%, and 40% had an induration of ≥10 mm, ≥5 mm, ≥2 mm, respectively, while 51% of 525 HIV-negative persons had an induration of ≥10 mm (P < 0.001). Mumps and candida positivity (reactions of ≥3 mm) were found in 94% and 78% of HIV-negative persons compared with 72% and 61% of HIV-positive persons, respectively (P < 0.001). Although HIV-positive persons had markedly less tuberculin reactivity even at higher CD4+ cell counts (>400 cells/μL), reactivity to mumps and candida was present in more than half of HIV-positive persons with low CD4+ cell counts (≤200 cells/μL). Reaction to control antigens did not predict tuberculin reactivity.

CONCLUSION: In this setting, tuberculin and anergy skin testing have a low predictive value in detecting M. tuberculosis infection in HIV-infected persons, and therefore such testing has a limited role in identifying HIV-infected persons who may benefit from tuberculosis preventive therapy programs.

Keywords: AIDS; Asia; HIV; Thailand; skin testing; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Research Institute of Tuberculosis, Tokyo, Japan; and Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA 2: Chiang Rai Hospital, Chiang Rai, Thailand 3: HIV/AIDS Collaboration, Nonthaburi, Thailand; and Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 4: HIV/AIDS Collaboration, Nonthaburi, Thailand 5: Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA 6: Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Publication date: October 1, 1997

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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