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Risk for Developing Tuberculosis among Anergic Patients Infected with HIV

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; and Dulce Lopez-Gay, MD
[+] Article, Author, and Disclosure Information

From the Hospital General Gregorio Maranon and Consejera de Salud de la Comunidad Autonoma, Madrid, Spain. Requests for Reprints: Santiago Moreno, MD, Servicio de Microbiologia Clinica y Unidad de Enfermedades Infecciosas-VIH, Hospital Gregorio Maranon, Dr. Esquerdo, 46. 28007 Madrid. Grant Support: By grant 92/1256 from the Fondo de Investigaciones Sanitarias de la Seguridad Social, Ministerio de Sanidad, Madrid.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(3):194-198. doi:10.7326/0003-4819-119-3-199308010-00003
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Objective: To assess the risk for development of tuberculosis among anergic patients infected with the human immunodeficiency virus (HIV).

Design: Retrospective cohort study.

Setting: Tertiary referral center.

Patients: All HIV-infected patients who had a baseline positive protein purified derivative test (PPD) and delayed-type hypersensitivity skin tests.

Measurements: Development of active tuberculosis.

Results: 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.

Conclusions: 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.


hiv ; tuberculosis





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