Instability of Tuberculin and Candida Skin Test Reactivity in HIV-Infected Ugandans

Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

Instability of Tuberculin and Candida Skin Test Reactivity in HIV-Infected Ugandans

American Journal of Respiratory and Critical Care Online (12/98) Vol. 158, No. 6, P. 1790
Johnson, John L.; Nyole, Sam; Okwera, Alphonse; et al.

Scientists from the Uganda-Case Western Reserve University Research Collaboration examined the factors associated with the stability of skin test responses to purified protein derivative (PPD) and candida antigens in HIV-infected Ugandans receiving isoniazid in a tuberculosis preventive therapy trial. According to the researchers, anergy testing has been used as an adjunct to tuberculin testing for determining Mycobacterium tuberculosis (MTB) infections. Just over one- quarter of the 4,058 HIV-infected subjects showed anergy, compared to 10 percent of 682 HIV-negative people. At follow- up, 42 percent of 139 initially anergic subjects no longer showed anergy, and two-thirds of these subjects had PPD reactions of less than 5 millimeters. Furthermore, 35 percent of 313 subjects who were initially PPD-positive had negative PPD at follow-up. The researchers conclude "first that anergy is unstable and second that anergy testing is unreliable in identifying HIV-infected adults who are not infected with MTB and should not be used routinely for this purpose in assessing indications for isoniazid preventive therapy."

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