Delayed-type hypersensitivity skin testing predicts progression to AIDS in HIV-infected patients

Stephen P. Blatt, Craig Hendrix, Clifford A. Butzin, Theodore M. Freeman, William W. Ward, Rex E. Hensley, Gregory P. Melcher, Daniel J. Donovan, R. Neal Boswell

Research output: Contribution to journalArticle

Abstract

Objective:To evaluate the prognostic significance of cutaneous delayed-type hypersensitivity (DTH) skin testing in persons infected with HIV. Design: Cohort study. Setting: United States Air Force (USAF) Medical Center. Patients: Consecutive sample of 889 HIV-infected USAF personnel or dependents undergoing their first staging evaluation from 1985 through August 1990 in the USAF HIV Natural History Study. Measurements: All patients were evaluated with DTH skin testing including purified protein derivative and four control skin test antigens: mumps, Candida, tetanus toxoid, and trichophyton. In addition, all patients underwent CD4+ T-cell surface marker determinations. The relation between DTH skin test response at first evaluation and progression to Walter Reed stage 6 (presence of an AIDS-defining opportunistic infection) was evaluated using Kaplan-Meier survival analysis. Results: Patients with more than 400 CD4+ T cells/ mm3 are more likely than those having fewer than 400 CD4+ T cells per mm3 to respond to at least one (94% compared with 67%, P <0.001) or at least two (86% compared with 45%, P <0.001) DTH skin tests. Mean CD4 counts are lower for anergic compared with nonanergic patients and for patients responding to a single control skin test compared with those responding to two or more skin tests (P <0.05). The DTH skin test response at first evaluation was also found to predict progression to AIDS; the relative risk at 5 years of follow-up was 2.5 (95% Cl, 1.2 to 5.2) for anergy compared with a single positive skin test and 3.0 (Cl, 1.4 to 6.2) for a single compared with two or more skin test responses. The DTH skin test response at first evaluation was a predictor of progression (P <0.001) when controlling for initial CD4 count and Walter Reed stage in a Cox proportional hazards regression analysis. Conclusions: The DTH skin test response, a functional measure of cellular immunity, is an independent predictor of progression to AIDS in persons with HIV.

Original languageEnglish (US)
Pages (from-to)177-184
Number of pages8
JournalAnnals of Internal Medicine
Volume119
Issue number3
StatePublished - Aug 1 1993
Externally publishedYes

Fingerprint

Delayed Hypersensitivity
Skin Tests
Acquired Immunodeficiency Syndrome
HIV
Skin
CD4 Lymphocyte Count
T-Lymphocytes
Air
Mumps
Trichophyton
Tetanus Toxoid
Opportunistic Infections
Military Personnel
Kaplan-Meier Estimate
Survival Analysis
Natural History
Candida
Cellular Immunity
Cohort Studies
Regression Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Blatt, S. P., Hendrix, C., Butzin, C. A., Freeman, T. M., Ward, W. W., Hensley, R. E., ... Boswell, R. N. (1993). Delayed-type hypersensitivity skin testing predicts progression to AIDS in HIV-infected patients. Annals of Internal Medicine, 119(3), 177-184.

Delayed-type hypersensitivity skin testing predicts progression to AIDS in HIV-infected patients. / Blatt, Stephen P.; Hendrix, Craig; Butzin, Clifford A.; Freeman, Theodore M.; Ward, William W.; Hensley, Rex E.; Melcher, Gregory P.; Donovan, Daniel J.; Boswell, R. Neal.

In: Annals of Internal Medicine, Vol. 119, No. 3, 01.08.1993, p. 177-184.

Research output: Contribution to journalArticle

Blatt, SP, Hendrix, C, Butzin, CA, Freeman, TM, Ward, WW, Hensley, RE, Melcher, GP, Donovan, DJ & Boswell, RN 1993, 'Delayed-type hypersensitivity skin testing predicts progression to AIDS in HIV-infected patients', Annals of Internal Medicine, vol. 119, no. 3, pp. 177-184.
Blatt SP, Hendrix C, Butzin CA, Freeman TM, Ward WW, Hensley RE et al. Delayed-type hypersensitivity skin testing predicts progression to AIDS in HIV-infected patients. Annals of Internal Medicine. 1993 Aug 1;119(3):177-184.
Blatt, Stephen P. ; Hendrix, Craig ; Butzin, Clifford A. ; Freeman, Theodore M. ; Ward, William W. ; Hensley, Rex E. ; Melcher, Gregory P. ; Donovan, Daniel J. ; Boswell, R. Neal. / Delayed-type hypersensitivity skin testing predicts progression to AIDS in HIV-infected patients. In: Annals of Internal Medicine. 1993 ; Vol. 119, No. 3. pp. 177-184.
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abstract = "Objective:To evaluate the prognostic significance of cutaneous delayed-type hypersensitivity (DTH) skin testing in persons infected with HIV. Design: Cohort study. Setting: United States Air Force (USAF) Medical Center. Patients: Consecutive sample of 889 HIV-infected USAF personnel or dependents undergoing their first staging evaluation from 1985 through August 1990 in the USAF HIV Natural History Study. Measurements: All patients were evaluated with DTH skin testing including purified protein derivative and four control skin test antigens: mumps, Candida, tetanus toxoid, and trichophyton. In addition, all patients underwent CD4+ T-cell surface marker determinations. The relation between DTH skin test response at first evaluation and progression to Walter Reed stage 6 (presence of an AIDS-defining opportunistic infection) was evaluated using Kaplan-Meier survival analysis. Results: Patients with more than 400 CD4+ T cells/ mm3 are more likely than those having fewer than 400 CD4+ T cells per mm3 to respond to at least one (94{\%} compared with 67{\%}, P <0.001) or at least two (86{\%} compared with 45{\%}, P <0.001) DTH skin tests. Mean CD4 counts are lower for anergic compared with nonanergic patients and for patients responding to a single control skin test compared with those responding to two or more skin tests (P <0.05). The DTH skin test response at first evaluation was also found to predict progression to AIDS; the relative risk at 5 years of follow-up was 2.5 (95{\%} Cl, 1.2 to 5.2) for anergy compared with a single positive skin test and 3.0 (Cl, 1.4 to 6.2) for a single compared with two or more skin test responses. The DTH skin test response at first evaluation was a predictor of progression (P <0.001) when controlling for initial CD4 count and Walter Reed stage in a Cox proportional hazards regression analysis. Conclusions: The DTH skin test response, a functional measure of cellular immunity, is an independent predictor of progression to AIDS in persons with HIV.",
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AU - Ward, William W.

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AU - Melcher, Gregory P.

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N2 - Objective:To evaluate the prognostic significance of cutaneous delayed-type hypersensitivity (DTH) skin testing in persons infected with HIV. Design: Cohort study. Setting: United States Air Force (USAF) Medical Center. Patients: Consecutive sample of 889 HIV-infected USAF personnel or dependents undergoing their first staging evaluation from 1985 through August 1990 in the USAF HIV Natural History Study. Measurements: All patients were evaluated with DTH skin testing including purified protein derivative and four control skin test antigens: mumps, Candida, tetanus toxoid, and trichophyton. In addition, all patients underwent CD4+ T-cell surface marker determinations. The relation between DTH skin test response at first evaluation and progression to Walter Reed stage 6 (presence of an AIDS-defining opportunistic infection) was evaluated using Kaplan-Meier survival analysis. Results: Patients with more than 400 CD4+ T cells/ mm3 are more likely than those having fewer than 400 CD4+ T cells per mm3 to respond to at least one (94% compared with 67%, P <0.001) or at least two (86% compared with 45%, P <0.001) DTH skin tests. Mean CD4 counts are lower for anergic compared with nonanergic patients and for patients responding to a single control skin test compared with those responding to two or more skin tests (P <0.05). The DTH skin test response at first evaluation was also found to predict progression to AIDS; the relative risk at 5 years of follow-up was 2.5 (95% Cl, 1.2 to 5.2) for anergy compared with a single positive skin test and 3.0 (Cl, 1.4 to 6.2) for a single compared with two or more skin test responses. The DTH skin test response at first evaluation was a predictor of progression (P <0.001) when controlling for initial CD4 count and Walter Reed stage in a Cox proportional hazards regression analysis. Conclusions: The DTH skin test response, a functional measure of cellular immunity, is an independent predictor of progression to AIDS in persons with HIV.

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