title: Risk for developing tuberculosis among anergic patients infected with HIV.
abstract: OBJECTIVE
  To assess the risk for development of tuberculosis among anergic patients infected with the human immunodeficiency virus (HIV).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  All HIV-infected patients who had a baseline positive protein purified derivative test (PPD) and delayed-type hypersensitivity skin tests.
  
  
  METHODS
  Development of active tuberculosis.
  
  
  RESULTS
  Of 374 patients, 108 (29%) had positive results of PPD tests, 154 (41%) had negative results of PPD tests but no skin anergy, and 112 (30%) were anergic. Conversion of the PPD to positive was observed in 10 of 67 (15%) patients with previously negative results of PPD tests and no anergy and in 3 of 36 (8%) anergic patients who were retested during the follow-up period (mean, 26 months). The risk for active tuberculosis to develop in patients not receiving isoniazid chemoprophylaxis was similar in patients with a positive PPD test result (10.4 cases per 100 person-years) and in anergic patients (12.4 cases per 100 person-years) and higher in both groups than in nonanergic patients with a negative PPD test result (5.4 cases per 100 person-years). Tuberculosis was more frequent among intravenous drug abusers with no previous isoniazid treatment (63 of 290, 22%) than among homosexual men (0 of 29) or patients in other HIV transmission categories (0 of 31). Preventive therapy with isoniazid reduced tuberculosis development (4% as compared with 31%; P = 0.008). Among 15 anergic patients who had CD4 counts measured within 3 months of tuberculosis development, only 1 (7%) had more than 500 CD4 cells/mm3.
  
  
  CONCLUSIONS
  Anergic HIV-infected patients are at high risk for development of tuberculosis. Anergic HIV-infected patients, in addition to HIV-infected patients with positive results of PPD tests, should be offered preventive therapy if they live in areas with a high prevalence of tuberculosis, at least when the CD4 count decreases to less than 500 CD4 cells/mm3.
authors.affiliation: Hospital General Gregorio Marãnón, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Moreno
authors.forename: J
authors.initials: J
authors.lastname: Baraia-Etxaburu
authors.forename: E
authors.initials: E
authors.lastname: Bouza
authors.forename: F
authors.initials: F
authors.lastname: Parras
authors.forename: M
authors.initials: M
authors.lastname: Pérez-Tascón
authors.forename: P
authors.initials: P
authors.lastname: Miralles
authors.forename: T
authors.initials: T
authors.lastname: Vicente
authors.forename: J C
authors.initials: JC
authors.lastname: Alberdi
authors.forename: J
authors.initials: J
authors.lastname: Cosín
authors.forename: D
authors.initials: D
authors.lastname: López-Gay
mesh_terms: D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology; D007108:Immune Tolerance; D007428:Intradermal Tests; D007538:Isoniazid / Q000627:therapeutic use; D007958:Leukocyte Count; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000209:etiology / Q000276:immunology* / Q000517:prevention & control
chemical_list: D007538:Isoniazid