Delayed-type hypersensitivity skin test reactivity and survival in HIV-infected patients in Uganda: Should anergy be a criterion to start antiretroviral therapy in low-income countries?

Edward C. Jones-López, Alphonse Okwera, Harriet Mayanja-Kizza, Jerrold J. Ellner, Roy D. Mugerwa, Christopher C. Whalen

Research output: Contribution to journalArticlepeer-review

Abstract

Access to antiretroviral (ARV) drugs is improving in sub-Saharan Africa but still constrained by several clinical and logistical obstacles. There is a need to develop affordable markers to guide initiation of treatment. We present a prospective cohort study of 779 patients participating in a TB prophylaxis trial. We performed separate analyses for anergic and nonanergic subjects. Prognostic factors for anergic and nonanergic subjects differed between groups. Individuals with anergy and constitutional symptoms were at the highest risk of death. Incident tuberculosis and CD4 <200 cells/μL at enrollment were the strongest risk factors for death. HIV disease is associated with substantial morbidity and mortality in this population. The burden caused by tuberculosis is particularly high. Anergy is a strong and independent predictor of death. World Health Organization criteria to start ARV may be strengthened with the addition of DTH testing, an inexpensive and readily available tool in sub-Saharan Africa.

Original languageEnglish (US)
Pages (from-to)154-161
Number of pages8
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume74
Issue number1
StatePublished - Jan 2006
Externally publishedYes

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases

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