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- Title
Delayed-type hypersensitivity skin testing predicts progression to AIDS in HIV-infected patients.
- Authors
Blatt, Stephen P.; Hendrix, Craig W.; Butzin, Clifford A.; Freeman, Theodore M.; Ward, William W.; Hensley, Rex E.; Melcher, Gregory P.; Donovan, Daniel J.; Boswell, R. Neal; Blatt, S P; Hendrix, C W; Butzin, C A; Freeman, T M; Ward, W W; Hensley, R E; Melcher, G P; Donovan, D J; Boswell, R N
- Abstract
<bold>Objective: </bold>To evaluate the prognostic significance of cutaneous delayed-type hypersensitivity (DTH) skin testing in persons infected with HIV.<bold>Design: </bold>Cohort study.<bold>Setting: </bold>United States Air Force (USAF) Medical Center.<bold>Patients: </bold>Consecutive sample of 889 HIV-infected USAF personnel or dependents undergoing their first staging evaluation from 1985 through August 1990 in the USAF HIV Natural History Study.<bold>Measurements: </bold>All patients were evaluated with DTH skin testing including purified protein derivative and four control skin test antigens: mumps, candida, tetanus toxoid, and trichophyton. In addition, all patients underwent CD4+ T-cell surface marker determinations. The relation between DTH skin test response at first evaluation and progression to Walter Reed stage 6 (presence of an AIDS-defining opportunistic infection) was evaluated using Kaplan-Meier survival analysis.<bold>Results: </bold>Patients with more than 400 CD4+ T cells/mm3 are more likely than those having fewer than 400 CD4+ T cells per mm3 to respond to at least one (94% compared with 67%, P < 0.001) or at least two (86% compared with 45%, P < 0.001) DTH skin tests. Mean CD4 counts are lower for anergic compared with nonanergic patients and for patients responding to a single control skin test compared with those responding to two or more skin tests (P < 0.05). The DTH skin test response at first evaluation was also found to predict progression to AIDS; the relative risk at 5 years of follow-up was 2.5 (95% CI, 1.2 to 5.2) for anergy compared with a single positive skin test and 3.0 (CI, 1.4 to 6.2) for a single compared with two or more skin test responses. The DTH skin test response at first evaluation was a predictor of progression (P < 0.001) when controlling for initial CD4 count and Walter Reed stage in a Cox proportional hazards regression analysis.<bold>Conclusions: </bold>The DTH skin test response, a functional measure of cellular immunity, is an independent predictor of progression to AIDS in persons with HIV.
- Subjects
DELAYED hypersensitivity; SKIN tests; HIV; T cells
- Publication
Annals of Internal Medicine, 1993, Vol 119, Issue 3, p177
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-119-3-199308010-00001