The effect of immunodeficiency on cutaneous delayed-type hypersensitivity testing in HIV-infected women without anergy: implications for tuberculin testing. HER Study Group. HIV Epidemiology Research.
METHODS
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.


METHODS
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 < or = 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 > or =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).


CONCLUSIONS
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.
Klein
R S
RS
Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467, USA. klein@aecom.yu.edu
Flanigan
T
T
Schuman
P
P
Smith
D
D
Vlahov
D
D
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D018791:CD4 Lymphocyte Count; D002175:Candida / Q000276:immunology; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000382:microbiology*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology*; D008875:Middle Aged; D009107:Mumps / Q000276:immunology; D016017:Odds Ratio; D012882:Skin Tests; D018709:Statistics, Nonparametric; D013742:Tetanus / Q000276:immunology; D014376:Tuberculosis / Q000175:diagnosis* / Q000276:immunology / Q000821:virology