Am. J. Respir. Crit. Care Med., Vol 151, No. 3, Mar 1995, 805-808.
Two-stage tuberculin skin testing in individuals with human immunodeficiency virus infection. Community Programs for Clinical Research on AIDS
CT Webster, FM Gordin, JP Matts, JA Korvick, C Miller, K Muth, LS Brown, CL Besch, JO Kumi and C Salveson
Richmond AIDS Consortium, Virginia 23298-0049.
In this study we estimated occurrence of the booster effect in a population
infected with the human immunodeficiency virus (HIV) and assessed the
relation between the booster effect, T-lymphocyte CD4 cell counts,
tuberculosis risk categories, and HIV exposure categories. Patients were
recruited from 13 participating sites of the Terry Beirn Community Programs
for Clinical Research on AIDS (CPCRA). A two-stage tuberculin skin test was
applied to 709 HIV-infected patients using the Mantoux method. An
induration reading < 5 mm on the first test and > or = 5 on the
second skin test defined the booster effect. Overall, 18 patients, or 2.7%
(95% confidence interval, 1.6 to 4.2) experienced the booster effect.
Boosted responses were seen in eight (2.1%) anergic patients, six (4.5%)
nonanergic patients, and four (2.5%) with anergy status unknown. Boosting
was noted in 1 of the 131 women enrolled. Age, race, CD4 cell count,
injection drug use, anergy status, tuberculosis risk categories, and HIV
exposure categories were not predictive of boosting. The booster effect
occurs in a small percentage of HIV- infected patients tested, thus
identifying small numbers of patients with latent tuberculosis infection.
The two-stage procedure is probably of limited value in the diagnosis of
latent tuberculosis in HIV- infected persons.
