title: Utility of tuberculin and anergy skin testing in predicting tuberculosis infection in human immunodeficiency virus-infected persons in Thailand.
abstract: METHODS
  Chiang Rai, the northernmost province of Thailand, where extensive human immunodeficiency virus (HIV) transmission has resulted in a rapid increase in tuberculosis.
  
  
  OBJECTIVE
  To assess the utility of tuberculin and anergy skin testing to identify latent Mycobacterium tuberculosis infection in HIV-infected persons.
  
  
  METHODS
  A cross-sectional study and analysis were conducted to examine reactivity to tuberculin and two control antigens (mumps and candida) in HIV-negative and HIV-positive blood donors and female sex workers.
  
  
  RESULTS
  HIV-positive persons had markedly decreased tuberculin reactivity; 14%, 19%, and 40% had an induration of > or = 10 mm, > or = 5 mm, > or = 2 mm, respectively, while 51% of 525 HIV-negative persons had an induration of > or = 10 mm (P < 0.001). Mumps and candida positivity (reactions of > or = 3 mm) were found in 94% and 78% of HIV-negative persons compared with 72% and 61% of HIV-positive persons, respectively (P < 0.001). Although HIV-positive persons had markedly less tuberculin reactivity even at higher CD4+ cell counts (> 400 cells/microL), reactivity to mumps and candida was present in more than half of HIV-positive persons with low CD4+ cell counts (< or = 200 cells/microL). Reaction to control antigens did not predict tuberculin reactivity.
  
  
  CONCLUSIONS
  In this setting, tuberculin and anergy skin testing have a low predictive value in detecting M. tuberculosis infection in HIV-infected persons, and therefore such testing has a limited role in identifying HIV-infected persons who may benefit from tuberculosis preventive therapy programs.
authors.affiliation: Research Institute of Tuberculosis, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yanai
authors.forename: W
authors.initials: W
authors.lastname: Uthaivoravit
authors.forename: T D
authors.initials: TD
authors.lastname: Mastro
authors.forename: K
authors.initials: K
authors.lastname: Limpakarnjanarat
authors.forename: P
authors.initials: P
authors.lastname: Sawanpanyalert
authors.forename: R H
authors.initials: RH
authors.lastname: Morrow
authors.forename: P
authors.initials: P
authors.lastname: Nieburg
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D000328:Adult; D000704:Analysis of Variance; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013785:Thailand / Q000453:epidemiology; D014374:Tuberculin Test / Q000379:methods*; D014376:Tuberculosis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*