DELAYED-TYPE HYPERSENSITIVITY ANERGY IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PERSONS SCREENED FOR INFECTION WITH MYCOBACTERIUM-TUBERCULOSIS

A total of 479 human immunodeficiency virus (HIV)-infected persons at an HIV clinic in Florida and a tuberculosis clinic in New Jersey were skin-tested with tuberculin, tetanus toroid, mumps antigen, and Candid a antigen in a study of the prevalence of delayed-type hypersensitivit y (DTH) anergy and the usefulness of two-step tuberculin testing in th is population. Of the patients tested, 12% had a positive (greater tha n or equal to 5-mm) response to tuberculin; 57%, 45%, and 35% had a po sitive (greater than or equal to 3-mm) response to Candida antigen, te tanus toroid, and mumps antigen, respectively; and 31% were anergic (< 3 mm of induration in response to each antigen). In a multivariate log istic regression model, anergy was significantly associated with a his tory of Kaposi's sarcoma, Pneumocystis carinii pneumonia, or oral cand idiasis and with White race. Anergy was four times and 15 times as lik ely for persons with CD4(+) T-lymphocyte counts of 200-400/mm(3) and < 200/mm(3), respectively, as for persons with >499 CD4(+) T lymphocytes /mm(3). Of 103 patients who were tuberculin-tested a second time after their initial test result was negative, seven had greater than or equ al to 5 mm of induration in response to the second test; only one of t hese patients was anergic at the initial screening. The findings of th is study indicate that DTH antigens should be used in conjunction with tuberculin testing and that two-step tuberculin testing is not an alt ernative to anergy testing but may be useful for the detection of infe ction with Mycobacterium tuberculosis in nonanergic HIV-infected patie nts.