RELIABILITY OF ANERGY SKIN TESTING IN PERSONS WITH HIV-INFECTION

Testing with antigens that elicit delayed-type cutaneous hypersensitiv ity reactions is commonly used to evaluate immune competence in person s infected with the human immunodeficiency virus; however, the reliabi lity of such testing has not been determined. We performed serial test ing with tuberculin, mumps, and Candida antigens in 491 HIV-infected p ersons and found that 30% of persons who initially had no reaction (0 mm) to any of the three antigens, and, thus, were considered to be ane rgic, had reaction to the mumps or Candida antigen when they were rete sted 12 months later. We also examined the results of mumps antigen te sts in 50 subjects who had a negative tuberculin tests after an initia l positive test. The mumps antigen test was positive in 39% of the sub jects when the tuberculin test was falsely negative. We conclude that tests commonly used to define anergy cannot reliably identify the aner gic state. Moreover, using the mumps antigen to aid in the interpretat ion of the tuberculin test will often lead to erroneous conclusions. T hese data indicate that the results of anergy testing should not be us ed to make individual patient decisions concerning preventive therapy for tuberculosis.