Am. J. Respir. Crit. Care Med., Vol 154, No. 4, 10 1996, 1029-1033.
Lack of association of induration size with HIV infection among drug users reacting to tuberculin
MN Gourevitch, D Hartel, EE Schoenbaum and RS Klein
Department of Epidemiology and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Smaller tuberculin test induration sizes suggest eligibility for
tuberculosis chemoprophylaxis in HIV-seropositive than in HIV- seronegative
persons. To determine whether human immunodeficiency virus (HIV) infection
is associated with induration size among tuberculin reactors, a
cross-sectional study of HIV-seropositive and -seronegative drug users was
performed. Twenty-four of 160 (15%) HIV-seropositive and 68 of 284 (24%)
HIV-seronegative patients had reactions to purified protein derivative
(PPD) of > or = 2 mm (OR = 0.56, 95% CI 0.32 to 0.96). However, the
prevalence of tuberculin reactivity was equal among nonanergic subjects
with and without HIV infection. Median induration size was similar among
HIV-seropositive (20.5 mm) and -seronegative (17.5 mm) reactors. Thus,
although HIV-seropositive patients were less likely, due to cutaneous
anergy, to be PPD reactors, induration size was not associated with HIV
infection among reactors. Although using a reduced cutpoint to determine
suitability of chemoprophylaxis in HIV- seropositive persons may be
prudent, the logical assumption that the loss of specificity this entails
is accompanied by an increase in sensitivity for detecting Mycobacterium
tuberculosis infection remains to be proved.
