Criteria for assessing cutaneous anergy in women with or at risk for HIV infection

Background: Controversy exists about both the clinical utility of anergy te sting and the optimal criteria for defining anergy. Objective: We sought to assess various definitions of cutaneous anergy for ability to distinguish HIV status, level of immunodeficiency, and ability t o mount a tuberculin reaction among women with or at risk for HIV infection . Methods: HIV-seropositive (n = 721) and HIV-seronegative (n = 358) at-risk women at academic medical centers in Baltimore, Detroit, New York, and Prov idence had cutaneous testing with mumps, Candida, tetanus toroid, and tuber culin antigens. Associations with HIV status and CD4+ lymphocyte levels mer e analyzed. Results: Candida, mumps, and tetanus antigens alone or in combination elici ted reactions significantly less often in HIV-seropositive than in HIV-sero negative women and less often in seropositive women with lower CD4+ counts, regardless of induration cutpoint chosen to define a positive reaction. Th e best antigen combinations far distinguishing groups included tetanus and mumps. Some women nonreactive to the 3 antigens ("anergic") had positive tu berculin reactions among both seropositive subjects (range, 1.1% to 2.9% de pending on induration cutpoint for defining anergy) and seronegative subjec ts (range, 8.9% to 14%). Conclusion: Absence of reactions to Candida, mumps, and tetanus antigens al one or in combination and at any induration cutpoint is associated with HIV status and with CD4+ level. Combinations, including tetanus and mumps anti gens with an induration cutpoint of less than 2 mm, mag be the best for def ining anergy.