The effect of immunodeficiency on cutaneous delayed-type hypersensitivity testing in HIV-infected women without anergy: Implications for tuberculin testing

Robert S. Klein; T. Flanigan; P. Schuman; D. Smith; D. Vlahov; E. E. Schoenbaum; R. D. Burk; B. Greenberg; P. Demas; C. Carpenter; K. Mayer; S. Cu-Uvin; M. Mileno; R. Boland; J. Peipert; M. Stein; J. Rich; A. Rompalo; L. Solomon; J. Anderson; A. Muñoz; K. Nelson; J. Margolick; K. Shah; A. Gleghorn; N. Graham; J. Sobel; C. Christensen; W. Brown; S. Ohmit; W. D. Lancaster; A. Eyler; D. Warren; A. Duerr; J. Moore; B. Peterson; S. Holmberg; L. K. Schrager; B. Unger; S. L. Melnick; S. McKinlay; H. Mitchell; L. Kalish; S. Barkin; A. Tinajero; D. Jones; S. Alperin

The effect of immunodeficiency on cutaneous delayed-type hypersensitivity testing in HIV-infected women without anergy: Implications for tuberculin testing

Robert S. Klein, T. Flanigan, P. Schuman, D. Smith, D. Vlahov, E. E. Schoenbaum, R. D. Burk, B. Greenberg, P. Demas, C. Carpenter, K. Mayer, S. Cu-Uvin, M. Mileno, R. Boland, J. Peipert, M. Stein, J. Rich, A. Rompalo, L. Solomon, J. AndersonA. Muñoz, K. Nelson, J. Margolick, K. Shah, A. Gleghorn, N. Graham, J. Sobel, C. Christensen, W. Brown, S. Ohmit, W. D. Lancaster, A. Eyler, D. Warren, A. Duerr, J. Moore, B. Peterson, S. Holmberg, L. K. Schrager, B. Unger, S. L. Melnick, S. McKinlay, H. Mitchell, L. Kalish, S. Barkin, A. Tinajero, D. Jones, S. Alperin

Bloomberg School of Public Health

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

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.

Original language	English (US)
Pages (from-to)	681-688
Number of pages	8
Journal	International Journal of Tuberculosis and Lung Disease
Volume	3
Issue number	8
State	Published - Aug 1999

Keywords

Delayed type hypersensitivity testing
HIV
Skin tests
Tuberculin testing
Women

ASJC Scopus subject areas

General Medicine

Cite this

Klein, R. S., Flanigan, T., Schuman, P., Smith, D., Vlahov, D., Schoenbaum, E. E., Burk, R. D., Greenberg, B., Demas, P., Carpenter, C., Mayer, K., Cu-Uvin, S., Mileno, M., Boland, R., Peipert, J., Stein, M., Rich, J., Rompalo, A., Solomon, L., ... Alperin, S. (1999). The effect of immunodeficiency on cutaneous delayed-type hypersensitivity testing in HIV-infected women without anergy: Implications for tuberculin testing. International Journal of Tuberculosis and Lung Disease, 3(8), 681-688.

The effect of immunodeficiency on cutaneous delayed-type hypersensitivity testing in HIV-infected women without anergy: Implications for tuberculin testing. / Klein, Robert S.; Flanigan, T.; Schuman, P. et al.
In: International Journal of Tuberculosis and Lung Disease, Vol. 3, No. 8, 08.1999, p. 681-688.

Research output: Contribution to journal › Article › peer-review

Klein, RS, Flanigan, T, Schuman, P, Smith, D, Vlahov, D, Schoenbaum, EE, Burk, RD, Greenberg, B, Demas, P, Carpenter, C, Mayer, K, Cu-Uvin, S, Mileno, M, Boland, R, Peipert, J, Stein, M, Rich, J, Rompalo, A, Solomon, L, Anderson, J, Muñoz, A, Nelson, K, Margolick, J, Shah, K, Gleghorn, A, Graham, N, Sobel, J, Christensen, C, Brown, W, Ohmit, S, Lancaster, WD, Eyler, A, Warren, D, Duerr, A, Moore, J, Peterson, B, Holmberg, S, Schrager, LK, Unger, B, Melnick, SL, McKinlay, S, Mitchell, H, Kalish, L, Barkin, S, Tinajero, A, Jones, D & Alperin, S 1999, 'The effect of immunodeficiency on cutaneous delayed-type hypersensitivity testing in HIV-infected women without anergy: Implications for tuberculin testing', International Journal of Tuberculosis and Lung Disease, vol. 3, no. 8, pp. 681-688.

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title = "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.",

keywords = "Delayed type hypersensitivity testing, HIV, Skin tests, Tuberculin testing, Women",

author = "Klein, {Robert S.} and T. Flanigan and P. Schuman and D. Smith and D. Vlahov and Schoenbaum, {E. E.} and Burk, {R. D.} and B. Greenberg and P. Demas and C. Carpenter and K. Mayer and S. Cu-Uvin and M. Mileno and R. Boland and J. Peipert and M. Stein and J. Rich and A. Rompalo and L. Solomon and J. Anderson and A. Mu{\~n}oz and K. Nelson and J. Margolick and K. Shah and A. Gleghorn and N. Graham and J. Sobel and C. Christensen and W. Brown and S. Ohmit and Lancaster, {W. D.} and A. Eyler and D. Warren and A. Duerr and J. Moore and B. Peterson and S. Holmberg and Schrager, {L. K.} and B. Unger and Melnick, {S. L.} and S. McKinlay and H. Mitchell and L. Kalish and S. Barkin and A. Tinajero and D. Jones and S. Alperin",

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T1 - The effect of immunodeficiency on cutaneous delayed-type hypersensitivity testing in HIV-infected women without anergy

T2 - Implications for tuberculin testing

AU - Klein, Robert S.

AU - Flanigan, T.

AU - Schuman, P.

AU - Smith, D.

AU - Vlahov, D.

AU - Schoenbaum, E. E.

AU - Burk, R. D.

AU - Greenberg, B.

AU - Demas, P.

AU - Carpenter, C.

AU - Mayer, K.

AU - Cu-Uvin, S.

AU - Mileno, M.

AU - Boland, R.

AU - Peipert, J.

AU - Stein, M.

AU - Rich, J.

AU - Rompalo, A.

AU - Solomon, L.

AU - Anderson, J.

AU - Muñoz, A.

AU - Nelson, K.

AU - Margolick, J.

AU - Shah, K.

AU - Gleghorn, A.

AU - Graham, N.

AU - Sobel, J.

AU - Christensen, C.

AU - Brown, W.

AU - Ohmit, S.

AU - Lancaster, W. D.

AU - Eyler, A.

AU - Warren, D.

AU - Duerr, A.

AU - Moore, J.

AU - Peterson, B.

AU - Holmberg, S.

AU - Schrager, L. K.

AU - Unger, B.

AU - Melnick, S. L.

AU - McKinlay, S.

AU - Mitchell, H.

AU - Kalish, L.

AU - Barkin, S.

AU - Tinajero, A.

AU - Jones, D.

AU - Alperin, S.

PY - 1999/8

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N2 - 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.

AB - 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.

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KW - HIV

KW - Skin tests

KW - Tuberculin testing

KW - Women

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The effect of immunodeficiency on cutaneous delayed-type hypersensitivity testing in HIV-infected women without anergy: Implications for tuberculin testing

Abstract

Keywords

ASJC Scopus subject areas

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