García-García M L, Valdespino-Gómez J L, García-Sancho C, Mayar-Maya M E, Palacios-Martínez M, Balandrano-Campos S, Escobar-Gutiérrez A, Peruga A, Weissenbacher M, Daniels E
Instituto Nacional de Salud Pública, Cuernavaca, M éxico.
Int J Epidemiol. 2000 Apr;29(2):369-75. doi: 10.1093/ije/29.2.369.
This study aimed to evaluate purified protein derivative (PPD) reactivity and its interrelationship with anergy panel and CD4+ lymphocytes in HIV-infected subjects as compared to PPD reactivity in HIV-uninfected individuals in a tuberculosis endemic and high Bacillus Calmette-Guérin (BCG) coverage environment.
Clients of four Mexico City HIV detection centres were screened for HIV-1 antibodies (ELISA or haemagglutination, Western Blot); reactivity to PPD (Mantoux PPD, 5TU RT-23), Candida (1:1000, 0.1 ml), and tetanus toxoid (10Lf, 0.1 ml); and CD4+ T cells. Active tuberculosis was excluded. Informed consent was obtained.
From 5130 clients 1168 subjects were enrolled; of these 801 (68.6%) were HIV positive. Reactivity to PPD among HIV-positive subjects was found in 174 (22%), 261 (32.6%), and 296 (37%), at PPD cutoff levels of > or =10 mm, > or =5 mm, and > or =2 mm as compared to 224 (61%) of 367 HIV-negative individuals' reactors to PPD (> or =10 mm) (P < 0.001). After exclusion of anergic individuals using two cutoff levels for cutaneous allergens (< or =2 mm and < or =5 mm), PPD reactivity between HIV-infected and uninfected individuals continued to be significantly different. Only HIV-infected individuals with CD4+ T cells > or =500 cells/mm3 had similar reactivity to PPD as HIV-uninfected individuals. Variables associated with PPD reactivity were CD4+ T cell counts, BCG scar, HIV infection and age.
PPD reactivity was useful to diagnose tuberculosis infection only among HIV-infected individuals with CD4+ counts > or =500 cells/mm3. Among individuals with lower counts, lowering cutoff levels or using anergy panel did not permit comparable reactivity as that observed among HIV-uninfected individuals.
本研究旨在评估在结核病流行且卡介苗（BCG）接种率高的环境中，与未感染HIV的个体相比，HIV感染个体中纯化蛋白衍生物（PPD）反应性及其与无反应性检测组和CD4 +淋巴细胞的相互关系。
对墨西哥城四个HIV检测中心的客户进行HIV-1抗体筛查（ELISA或血凝试验、免疫印迹法）；检测对PPD（结核菌素纯蛋白衍生物，5TU RT-23）、念珠菌（1:1000，0.1 ml）和破伤风类毒素（10Lf，0.1 ml）的反应性；以及CD4 + T细胞。排除活动性结核病患者。获得知情同意。
从5130名客户中招募了1168名受试者；其中801名（68.6%）为HIV阳性。HIV阳性受试者中，PPD截断值分别为≥10 mm、≥5 mm和≥2 mm时，PPD反应性的比例分别为174名（22%）、261名（32.6%）和296名（37%），相比之下，367名HIV阴性个体中有224名（61%）对PPD反应（≥10 mm）（P < 0.001）。使用两种皮肤过敏原截断值（≤2 mm和≤5 mm）排除无反应性个体后，HIV感染个体和未感染个体之间的PPD反应性仍有显著差异。只有CD4 + T细胞≥500个/立方毫米的HIV感染个体与未感染HIV的个体对PPD的反应性相似。与PPD反应性相关的变量有CD4 + T细胞计数、卡介苗疤痕、HIV感染和年龄。
PPD反应性仅对CD4 +细胞计数≥500个/立方毫米的HIV感染个体诊断结核感染有用。在CD4 +细胞计数较低的个体中，降低截断值或使用无反应性检测组并不能产生与未感染HIV个体中观察到的相当的反应性。
