Instability of Delayed-type Hypersensitivity Skin Test Anergy in Human Immunodeficiency Virus Infection

Waleska T. Caiaffa, Neil M H Graham, Noya Galai, Rosetta T. Rizzo, Kenrad Edwin Nelson, David Vlahov

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate stability of delayed-type hypersensitivity (DTH) skin test over time in human immunodeficiency virus (HIV)—seropositive and HIV-seronegative injecting drug users. Method: A community-based cohort of injecting drug users who had serial skin testing with purified protein derivative tuberculin, mumps, and Candida albicans antigen. Delayed-type hypersensitivity anergy was defined as a skin test result of less than 3 mm for all three antigens; DTH positivity was a skin test result of 3 mm or greater for at least one antigen (Centers for Disease Control and Prevention, Atlanta, Ga, 1993). Results: At baseline, 36% of HIV-seropositive subjects (n=401) were anergic as compared with 14% of HIV-seronegative subjects (n=552; P9/L (odds ratio=6.4) and less than 0.35×109/L (odds ratio=11.2) were more likely to remain anergic than those who had CD4 cell counts above 0.50×109/L or were HIV seronegative. Conclusions: Although the prevalence and incidence of DTH anergy were higher in HIV-seropositive subjects, high rates of change in DTH status occurred in both directions. This suggests that instability of DTH skin testing is substantial and only partially dependent on HIV status. Although a single test may be an unreliable indicator of HIV-induced immunosuppression, two consecutive anergic readings were strongly associated with a CD4 cell count below 0.50×109/L and particularly below 0.35×109/L. For determining false negativity of tuberculin tests, persistent DTH anergy is more reliable than a single test among HIV-seropositive injecting drug users. Anergy testing appears to be unnecessary with CD4 cell counts greater than 0.50×109/L.

Original languageEnglish (US)
Pages (from-to)2111-2117
Number of pages7
JournalArchives of Internal Medicine
Volume155
Issue number19
DOIs
StatePublished - Oct 23 1995

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Delayed Hypersensitivity
Virus Diseases
Skin Tests
HIV
CD4 Lymphocyte Count
Drug Users
Antigens
Odds Ratio
Mumps
Skin
Tuberculin Test
Tuberculin
Centers for Disease Control and Prevention (U.S.)
Candida albicans
Immunosuppression
Reading
Incidence

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Instability of Delayed-type Hypersensitivity Skin Test Anergy in Human Immunodeficiency Virus Infection. / Caiaffa, Waleska T.; Graham, Neil M H; Galai, Noya; Rizzo, Rosetta T.; Nelson, Kenrad Edwin; Vlahov, David.

In: Archives of Internal Medicine, Vol. 155, No. 19, 23.10.1995, p. 2111-2117.

Research output: Contribution to journalArticle

Caiaffa, Waleska T. ; Graham, Neil M H ; Galai, Noya ; Rizzo, Rosetta T. ; Nelson, Kenrad Edwin ; Vlahov, David. / Instability of Delayed-type Hypersensitivity Skin Test Anergy in Human Immunodeficiency Virus Infection. In: Archives of Internal Medicine. 1995 ; Vol. 155, No. 19. pp. 2111-2117.
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abstract = "Objective: To evaluate stability of delayed-type hypersensitivity (DTH) skin test over time in human immunodeficiency virus (HIV)—seropositive and HIV-seronegative injecting drug users. Method: A community-based cohort of injecting drug users who had serial skin testing with purified protein derivative tuberculin, mumps, and Candida albicans antigen. Delayed-type hypersensitivity anergy was defined as a skin test result of less than 3 mm for all three antigens; DTH positivity was a skin test result of 3 mm or greater for at least one antigen (Centers for Disease Control and Prevention, Atlanta, Ga, 1993). Results: At baseline, 36{\%} of HIV-seropositive subjects (n=401) were anergic as compared with 14{\%} of HIV-seronegative subjects (n=552; P9/L (odds ratio=6.4) and less than 0.35×109/L (odds ratio=11.2) were more likely to remain anergic than those who had CD4 cell counts above 0.50×109/L or were HIV seronegative. Conclusions: Although the prevalence and incidence of DTH anergy were higher in HIV-seropositive subjects, high rates of change in DTH status occurred in both directions. This suggests that instability of DTH skin testing is substantial and only partially dependent on HIV status. Although a single test may be an unreliable indicator of HIV-induced immunosuppression, two consecutive anergic readings were strongly associated with a CD4 cell count below 0.50×109/L and particularly below 0.35×109/L. For determining false negativity of tuberculin tests, persistent DTH anergy is more reliable than a single test among HIV-seropositive injecting drug users. Anergy testing appears to be unnecessary with CD4 cell counts greater than 0.50×109/L.",
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