Santiago Moreno, MD; Josu Baraia-Etxaburu, MD; Emilio Bouza, MD; Francisco Parras, MD; Miguel Perez-Tascon, MD; Pilar Miralles, MD; Teresa Vicente, MD; Juan C. Alberdi, MD; Jaime Cosn, MD; Dulce Lopez-Gay, MD
Moreno S, Baraia-Etxaburu J, Bouza E, Parras F, Perez-Tascon M, Miralles P, et al. Risk for Developing Tuberculosis among Anergic Patients Infected with HIV. Ann Intern Med. 1993;119:194-198. doi: 10.7326/0003-4819-119-3-199308010-00003
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Published: Ann Intern Med. 1993;119(3):194-198.
To assess the risk for development of tuberculosis among anergic patients infected with the human immunodeficiency virus (HIV).
Retrospective cohort study.
Tertiary referral center.
All HIV-infected patients who had a baseline positive protein purified derivative test (PPD) and delayed-type hypersensitivity skin tests.
Development of active tuberculosis.
Of 374 patients, 108 (29%) had positive results of PPD tests, 154 (41%) had negative results of PPD tests but no skin anergy, and 112 (30%) were anergic. Conversion of the PPD to positive was observed in 10 of 67 (15%) patients with previously negative results of PPD tests and no anergy and in 3 of 36 (8%) anergic patients who were retested during the follow-up period (mean, 26 months). The risk for active tuberculosis to develop in patients not receiving isoniazid chemoprophylaxis was similar in patients with a positive PPD test result (10.4 cases per 100 person-years) and in anergic patients (12.4 cases per 100 person-years) and higher in both groups than in nonanergic patients with a negative PPD test result (5.4 cases per 100 person-years). Tuberculosis was more frequent among intravenous drug abusers with no previous isoniazid treatment (63 of 290, 22%) than among homosexual men (0 of 29) or patients in other HIV transmission categories (0 of 31). Preventive therapy with isoniazid reduced tuberculosis development (4% as compared with 31%; P = 0.008). Among 15 anergic patients who had CD4 counts measured within 3 months of tuberculosis development, only 1 (7%) had more than 500 CD4 cells/mm3.
Anergic HIV-infected patients are at high risk for development of tuberculosis. Anergic HIV-infected patients, in addition to HIV-infected patients with positive results of PPD tests, should be offered preventive therapy if they live in areas with a high prevalence of tuberculosis, at least when the CD4 count decreases to less than 500 CD4 cells/mm3.
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Infectious Disease, Mycobacterial Infections.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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