Zidovudine-induced restoration of cell-mediated immunity to mycobacteria in immunodeficient HIV-infected patients

AIDS. 1992 Nov;6(11):1293-7. doi: 10.1097/00002030-199211000-00009.


Objective: To describe a localized form of Mycobacterium avium intracellulare (MAI) infection occurring concurrently with the restoration of cutaneous delayed-type hypersensitivity (DTH) responses to mycobacterial antigens after commencement of zidovudine therapy in immunodeficient HIV-infected patients.

Patients: The first 108 Western Australian patients with a CD4+ T-cell count of < 200 x 10(6)/l and/or symptomatic disease to be given zidovudine (ZDV), of whom 72 had adequate DTH data.

Methods: DTH responses to seven antigens were measured by the 'Multitest' method before and on at least two occasions during the 6 months after commencing ZDV. All patients were reviewed at regular intervals and clinical events recorded.

Results: Of the 64 patients who were anergic to tuberculin before commencing ZDV, 27 (42%) developed a DTH response to tuberculin after ZDV. Four of the nine patients with a 'Multitest' tuberculin response of > or = 8 mm and one patient who developed a positive Mantoux test to M. avium purified protein derivative developed an illness characterized by localized MAI infection, lymphadenopathy and/or severe fevers after 1-2 weeks.

Conclusions: The development of localized MAI infection and/or fevers shortly after commencing ZDV in immunodeficient HIV-infected patients may reflect restoration of cellular immunity to mycobacterial antigens in some patients rather than early failure of therapy or hypersensitivity to ZDV.

MeSH terms

  • AIDS-Related Opportunistic Infections / complications
  • AIDS-Related Opportunistic Infections / immunology
  • Antigens, Bacterial
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / immunology*
  • Humans
  • Hypersensitivity, Delayed
  • Immunity, Cellular / drug effects*
  • Mycobacterium / immunology*
  • Mycobacterium avium Complex / immunology
  • Mycobacterium avium-intracellulare Infection / complications
  • Mycobacterium avium-intracellulare Infection / etiology
  • Mycobacterium avium-intracellulare Infection / immunology
  • Tuberculin / immunology
  • Zidovudine / adverse effects
  • Zidovudine / therapeutic use*


  • Antigens, Bacterial
  • Tuberculin
  • Zidovudine