Document 0015
 DOCN  M9610015
 TI    Instability of delayed-type hypersensitivity skin test anergy in human
       immunodeficiency virus infection.
 DT    9601
 AU    Caiaffa WT; Graham NM; Galai N; Rizzo RT; Nelson KE; Vlahov D;
       Department of Epidemiology, Johns Hopkins School of Hygiene and; Public
       Health, Baltimore, MD, USA.
 SO    Arch Intern Med. 1995 Oct 23;155(19):2111-7. Unique Identifier :
       AIDSLINE MED/96011571
 AB    OBJECTIVE: To evaluate stability of delayed-type hypersensitivity (DTH)
       skin test over time in human immunodeficiency virus (HIV)-seropositive
       and HIV-seronegative injecting drug users. METHOD: A community-based
       cohort of injecting drug users who had serial skin testing with purified
       protein derivative tuberculin, mumps, and Candida albicans antigen.
       Delayed-type hypersensitivity anergy was defined as a skin test result
       of less than 3 mm for all three antigens; DTH positivity was a skin test
       result of 3 mm or greater for at least one antigen (Centers for Disease
       Control and Prevention, Atlanta, Ga, 1993). RESULTS: At baseline, 36% of
       HIV-seropositive subjects (n = 401) were anergic as compared with 14% of
       HIV-seronegative subjects (n = 552; P < .001). During follow-up, fewer
       HIV-seropositive subjects remained DTH positive (42%) and more remained
       anergic (19%) than of HIV-seronegative subjects (67% and 7%,
       respectively). Twenty-four percent of HIV-seropositive subjects who were
       initially DTH positive became anergic as compared with 15.3% of the
       HIV-seronegative subjects. However, the proportion changing from anergy
       to DTH positivity was greater among HIV-seropositive subjects (15%) than
       HIV-seronegative subjects (12%). In comparison to those who remained DTH
       positive, HIV-seropositive subjects with CD4 cell counts of less than
       0.50 x 10(9)/L (odds ratio = 6.4) and less than 0.35 x 10(9)/L (odds
       ratio = 11.2) were more likely to remain anergic than those who had CD4
       cell counts above 0.50 x 10(9)/L or were HIV seronegative. CONCLUSIONS:
       Although the prevalence and incidence of DTH anergy were higher in
       HIV-seropositive subjects, high rates of change in DTH status occurred
       in both directions. This suggests that instability of DTH skin testing
       is substantial and only partially dependent on HIV status. Although a
       single test may be an unreliable indicator of HIV-induced
       immunosuppression, two consecutive anergic readings were strongly
       associated with a CD4 cell count below 0.50 x 10(9)/L and particularly
       below 0.35 x 10(9)/L. For determining false negativity of tuberculin
       tests, persistent DTH anergy is more reliable than a single test among
       HIV-seropositive injecting drug users. Anergy testing appears to be
       unnecessary with CD4 cell counts greater than 0.5 x 10(9)/L.
 DE    Adult  Aged  Candida albicans/IMMUNOLOGY  *Clonal Anergy  Cohort Studies
       Cross-Sectional Studies  CD4 Lymphocyte Count  Human  Hypersensitivity,
       Delayed/*IMMUNOLOGY  HIV Infections/ETIOLOGY/*IMMUNOLOGY  HIV
       Seropositivity/IMMUNOLOGY  Middle Age  Mumps/IMMUNOLOGY  Odds Ratio
       Risk Factors  Sensitivity and Specificity  *Skin Tests  Substance Abuse,
       Intravenous/COMPLICATIONS  Support, U.S. Gov't, P.H.S.  Tuberculin Test
       JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).