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, Ellie Schoenbaum, Robert 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

Research output: Contribution to journalArticle

7 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)681-688
Number of pages8
JournalInternational Journal of Tuberculosis and Lung Disease
Volume3
Issue number8
StatePublished - Aug 1999
Externally publishedYes

Fingerprint

Tuberculin
Delayed Hypersensitivity
HIV
Skin
CD4 Lymphocyte Count
Mumps
Antigens
Tetanus
Virus Diseases
Candida
Tetanus Toxoid
Demography

Keywords

  • Delayed type hypersensitivity testing
  • HIV
  • Skin tests
  • Tuberculin testing
  • Women

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

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.; Smith, D.; Vlahov, D.; Schoenbaum, Ellie; Burk, Robert 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.; Anderson, J.; Muñoz, A.; Nelson, K.; Margolick, J.; Shah, K.; Gleghorn, A.; Graham, N.; Sobel, J.; Christensen, C.; Brown, W.; Ohmit, S.; Lancaster, W. D.; Eyler, A.; Warren, D.; Duerr, A.; Moore, J.; Peterson, B.; Holmberg, S.; Schrager, L. K.; Unger, B.; Melnick, S. L.; McKinlay, S.; Mitchell, H.; Kalish, L.; Barkin, S.; Tinajero, A.; Jones, D.; Alperin, S.

In: International Journal of Tuberculosis and Lung Disease, Vol. 3, No. 8, 08.1999, p. 681-688.

Research output: Contribution to journalArticle

Klein, RS, Flanigan, T, Schuman, P, Smith, D, Vlahov, D, Schoenbaum, E, 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.
Klein, Robert S. ; Flanigan, T. ; Schuman, P. ; Smith, D. ; Vlahov, D. ; Schoenbaum, Ellie ; Burk, Robert 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. ; Anderson, J. ; Muñoz, A. ; Nelson, K. ; Margolick, J. ; Shah, K. ; Gleghorn, A. ; Graham, N. ; Sobel, J. ; Christensen, C. ; Brown, W. ; Ohmit, S. ; Lancaster, W. D. ; Eyler, A. ; Warren, D. ; Duerr, A. ; Moore, J. ; Peterson, B. ; Holmberg, S. ; Schrager, L. K. ; Unger, B. ; Melnick, S. L. ; McKinlay, S. ; Mitchell, H. ; Kalish, L. ; Barkin, S. ; Tinajero, A. ; Jones, D. ; Alperin, S. / The effect of immunodeficiency on cutaneous delayed-type hypersensitivity testing in HIV-infected women without anergy : Implications for tuberculin testing. In: International Journal of Tuberculosis and Lung Disease. 1999 ; Vol. 3, No. 8. pp. 681-688.
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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.",
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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, Ellie

AU - Burk, Robert 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

Y1 - 1999/8

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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