The effect of immunodeficiency on cutaneous delayed-type hypersensitivity testing in HIV-infected women without anergy: implications for tuberculin testing
Abstract:SETTING: A collaborative study in four urban medical centers in the United States.
OBJECTIVE: To determine the effect of human immunodeficiency virus (HIV) infection and immunodeficiency on delayed type hypersensitivity (DTH) responses and the implications for interpretation of tuberculin reactions in non-anergic women with or at risk for HIV infection.
DESIGN: Demographic and behavioral information, HIV antibody testing, CD4+ lymphocyte counts, and cutaneous responses to DTH testing with mumps, Candida, tetanus toxoid, and tuberculin (purified protein derivative—PPD) antigens were obtained in 1184 women.
RESULTS: Reactions to one or more of the four antigens occurred in 436 HIV-seropositive and 356 high-risk seronegative women. Among non-anergic women, HIV-seropositives were less likely (P ≤ 0.05) to react to mumps (62% vs 81%), tetanus (72% vs 84%), and PPD (13% vs 19%). Induration in HIV-seropositive reactors was associated with CD4+ cell level for mumps (P = 0.004) and tetanus (P < 0.001), but not for Candida or PPD. HIV-seropositive reactors with CD4+ cell counts >500/mm3 did not have significantly smaller reactions than HIV-seronegatives for any antigen tested. PPD sizes were similar among HIV-seropositive reactors with CD4+ cell counts >500/mm3 (12.4 ± 7.4 mm) and HIV-seronegative reactors (12.0 ± 8.3 mm); induration ≥10 mm was seen in 16/173 (9.2%) seropositive women with CD4+ cell counts >500/mm3 and 41/356 (11.5%) seronegative women, respectively (P = 0.5).
CONCLUSION: Among HIV-infected women able to react to a DTH antigen, induration in response to that antigen was relatively intact at CD4+ counts >500/mm3. This suggests that degree of immunodeficiency should be considered when interpreting PPD reactions in HIV-infected persons.
Document Type: Regular Paper
Affiliations: 1: Division of Infectious Diseases, Department of Medicine, and Department of Epidemiology and Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA 2: Division of Infectious Diseases, Department of Medicine, Miriam Hospital and Brown University School of Medicine, Providence, Rhode Island, USA 3: Division of Infectious Diseases, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA 4: Centers for Disease Control and Prevention, Atlanta, Georgia, USA 5: School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland, USA
Publication date: August 1, 1999
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