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. Anderson & 27 others 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

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

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