TY - JOUR
T1 - Criteria for assessing cutaneous anergy in women with or at risk for HIV infection
AU - Klein, Robert S.
AU - Flanigan, Timothy
AU - Schuman, Paula
AU - Smith, Dawn
AU - Vlahov, David
N1 - Funding Information:
Supported by cooperative agreements No. U64/CCU106795, U64/CCU206798, U64/CCU306802, and U64/CCU506831 with the Centers for Disease Control and Prevention.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1999
Y1 - 1999
N2 - Background: Controversy exists about both the clinical utility of anergy testing and the optimal criteria for defining anergy. Objective: We sought to assess various definitions of cutaneous anergy for ability to distinguish HIV status, level of immunodeficiency, and ability to mount a tuberculin reaction among women with or at risk for HIV infection. Methods: HIV-seropositive (n = 721) and HIV-seronegative (n = 358) at-risk women at academic medical centers in Baltimore, Detroit, New York, and Providence had cutaneous testing with mumps, Candida, tetanus toxoid, and tuberculin antigens. Associations with HIV status and CD4+ lymphocyte levels were analyzed. Results: Candida, mumps, and tetanus antigens alone or in combination elicited reactions significantly less often in HIV-seropositive than in HIV-seronegative women and less often in seropositive women with lower CD4+ counts, regardless of induration cutpoint chosen to define a positive reaction. The best antigen combinations for distinguishing groups included tetanus and mumps. Some women nonreactive to the 3 antigens ('anergie') had positive tuberculin reactions among both seropositive subjects (range, 1.1% to 2.9% depending on induration cutpoint for defining anergy) and seronegative subjects (range, 8.9% to 14%). Conclusion: Absence of reactions to Candida, mumps, and tetanus antigens alone or in combination and at any induration cutpoint is associated with HIV status and with CD4+ level. Combinations, including tetanus and thumps antigens with an induration cutpoint of less than 2 mm, may be the best for defining anergy.
AB - Background: Controversy exists about both the clinical utility of anergy testing and the optimal criteria for defining anergy. Objective: We sought to assess various definitions of cutaneous anergy for ability to distinguish HIV status, level of immunodeficiency, and ability to mount a tuberculin reaction among women with or at risk for HIV infection. Methods: HIV-seropositive (n = 721) and HIV-seronegative (n = 358) at-risk women at academic medical centers in Baltimore, Detroit, New York, and Providence had cutaneous testing with mumps, Candida, tetanus toxoid, and tuberculin antigens. Associations with HIV status and CD4+ lymphocyte levels were analyzed. Results: Candida, mumps, and tetanus antigens alone or in combination elicited reactions significantly less often in HIV-seropositive than in HIV-seronegative women and less often in seropositive women with lower CD4+ counts, regardless of induration cutpoint chosen to define a positive reaction. The best antigen combinations for distinguishing groups included tetanus and mumps. Some women nonreactive to the 3 antigens ('anergie') had positive tuberculin reactions among both seropositive subjects (range, 1.1% to 2.9% depending on induration cutpoint for defining anergy) and seronegative subjects (range, 8.9% to 14%). Conclusion: Absence of reactions to Candida, mumps, and tetanus antigens alone or in combination and at any induration cutpoint is associated with HIV status and with CD4+ level. Combinations, including tetanus and thumps antigens with an induration cutpoint of less than 2 mm, may be the best for defining anergy.
KW - Anergy
KW - Cellular immunity
KW - Delayed hypersensitivity
KW - Skin tests
UR - http://www.scopus.com/inward/record.url?scp=0032921072&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032921072&partnerID=8YFLogxK
U2 - 10.1016/S0091-6749(99)70531-2
DO - 10.1016/S0091-6749(99)70531-2
M3 - Article
C2 - 9893191
AN - SCOPUS:0032921072
SN - 0091-6749
VL - 103
SP - 93
EP - 98
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 1 I
ER -