Underestimation of Mycobacterium tuberculosis infection in HIV-infected subjects using reactivity to tuberculin and anergy panel

• Published in: International journal of epidemiology 2000-04, Vol.29 (2), p.369-375
• Main Authors: de Lourdes García-García, Ma, Valdespino-Gómez, Jose Luis, García-Sancho, Cecilia, Mayar-Maya, Ma. Eugenia, Palacios-Martínez, Manuel, Balandrano-Campos, Susana, Escobar-Gutiérrez, Alejandro, Peruga, Armando, Weissenbacher, Mercedes, Daniels, Elaine
• Format: Article
• Language: English
• Subjects: Adjuvants, Immunologic - therapeutic use; Adolescent; Adult; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - epidemiology; AIDS-Related Opportunistic Infections - microbiology; AIDS/HIV; anergy; Antibodies, Bacterial - analysis; BCG vaccine; BCG Vaccine - therapeutic use; Biological and medical sciences; CD4 Lymphocyte Count; CD4 lymphocytes; delayed-type hypersensitivity; Female; HIV; HIV Antibodies - analysis; HIV-1 - immunology; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Mexico - epidemiology; Mycobacterium tuberculosis; Mycobacterium tuberculosis - immunology; Prevalence; Tropical medicine; Tuberculin Test; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - microbiology; Urban Population; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0300-5771; 1464-3685
• DOI: 10.1093/ije/29.2.369

Background This study aimed to evaluate purified protein derivative (PPD) reactivity and its interrelationship with anergy panel and CD4+ lymphocytes in HIV-infected subjects as compared to PPD reactivity in HIV-uninfected individuals in a tuberculosis endemic and high Bacillus Calmette-Guérin (BCG) coverage environment. Methods Clients of four Mexico City HIV detection centres were screened for HIV-1 antibodies (ELISA or haemagglutination, Western Blot); reactivity to PPD (Mantoux PPD, 5TU RT-23), Candida (1:1000, 0.1 ml), and tetanus toxoid (10Lf, 0.1 ml); and CD4+ T cells. Active tuberculosis was excluded. Informed consent was obtained. Results From 5130 clients 1168 subjects were enrolled; of these 801 (68.6%) were HIV positive. Reactivity to PPD among HIV-positive subjects was found in 174 (22%), 261 (32.6%), and 296 (37%), at PPD cutoff levels of ≥10 mm, ≥5 mm, and ≥2 mm as compared to 224 (61%) of 367 HIV-negative individuals’ reactors to PPD (≥10 mm) (P < 0.001). After exclusion of anergic individuals using two cutoff levels for cutaneous allergens (≤2 mm and ≤5 mm), PPD reactivity between HIV-infected and uninfected individuals continued to be significantly different. Only HIV-infected individuals with CD4+ T cells ≥500 cells/mm3 had similar reactivity to PPD as HIV-uninfected individuals. Variables associated with PPD reactivity were CD4+ T cell counts, BCG scar, HIV infection and age. Conclusions PPD reactivity was useful to diagnose tuberculosis infection only among HIV-infected individuals with CD4+ counts ≥500 cells/mm3. Among individuals with lower counts, lowering cutoff levels or using anergy panel did not permit comparable reactivity as that observed among HIV-uninfected individuals.