AN 11-YEAR FOLLOW-UP OF DELAYED-TYPE HYPERSENSITIVITY TESTING FOR THEIDENTIFICATION OF HIV-1-INFECTED PATIENTS AT INCREASED RISK OF DEVELOPING AIDS

The objective of this study was to investigate whether testing of dela yed-type hypersensitivity (DTH) to recall antigens could be used to id entify HIV-1 infected patients at increased risk of death or developin g AIDS, Eighty-five HIV-1 infected Swedish homosexual men were tested for DTH using a commercially available kit with 7 recall antigens (Mul titest, Merieux). The patients were followed prospectively for 11 year s or until death, The 11-year actuarial progression rate to AIDS was 6 9% and to death 60%. Older age was identified as a factor predisposing to rapid progression independent of cell-mediated immunity measured b y DTH, Patients with a subnormal DTH had a significantly more rapid pr ogression to AIDS and death than did patients with normal DTH, and the time between AIDS diagnosis and death was shorter, For patients with a multiscore (MS) < 10 mm, the median time to AIDS was 59 months, the median time to death 88 months, and the median time from AIDS diagnosi s to death 11 months, compared to 106, 139, and 25 months, respectivel y, for patients with MS greater than or equal to 10 mm. Of the individ ual antigens, only a negative reaction to tuberculin was independently predictive of progression to all 3 endpoints, while a negative reacti on to tetanus was independently predictive of progression to death. Th us, determination of DTH improves the early recognition of patients at increased risk of progressive disease.