Delayed-type hypersensitivity skin testing predicts progression to AIDS in HIV-infected patients

Ann Intern Med. 1993 Aug 1;119(3):177-84. doi: 10.7326/0003-4819-119-3-199308010-00001.


Objective: To evaluate the prognostic significance of cutaneous delayed-type hypersensitivity (DTH) skin testing in persons infected with HIV.

Design: Cohort study.

Setting: United States Air Force (USAF) Medical Center.

Patients: Consecutive sample of 889 HIV-infected USAF personnel or dependents undergoing their first staging evaluation from 1985 through August 1990 in the USAF HIV Natural History Study.

Measurements: All patients were evaluated with DTH skin testing including purified protein derivative and four control skin test antigens: mumps, candida, tetanus toxoid, and trichophyton. In addition, all patients underwent CD4+ T-cell surface marker determinations. The relation between DTH skin test response at first evaluation and progression to Walter Reed stage 6 (presence of an AIDS-defining opportunistic infection) was evaluated using Kaplan-Meier survival analysis.

Results: Patients with more than 400 CD4+ T cells/mm3 are more likely than those having fewer than 400 CD4+ T cells per mm3 to respond to at least one (94% compared with 67%, P < 0.001) or at least two (86% compared with 45%, P < 0.001) DTH skin tests. Mean CD4 counts are lower for anergic compared with nonanergic patients and for patients responding to a single control skin test compared with those responding to two or more skin tests (P < 0.05). The DTH skin test response at first evaluation was also found to predict progression to AIDS; the relative risk at 5 years of follow-up was 2.5 (95% CI, 1.2 to 5.2) for anergy compared with a single positive skin test and 3.0 (CI, 1.4 to 6.2) for a single compared with two or more skin test responses. The DTH skin test response at first evaluation was a predictor of progression (P < 0.001) when controlling for initial CD4 count and Walter Reed stage in a Cox proportional hazards regression analysis.

Conclusions: The DTH skin test response, a functional measure of cellular immunity, is an independent predictor of progression to AIDS in persons with HIV.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acquired Immunodeficiency Syndrome / immunology*
  • Adolescent
  • Adult
  • Aged
  • Analysis of Variance
  • CD4-Positive T-Lymphocytes
  • Cohort Studies
  • Female
  • HIV Infections / immunology*
  • Humans
  • Hypersensitivity, Delayed / immunology
  • Leukocyte Count
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Skin Tests*
  • Survival Analysis
  • Tuberculin Test