French M A, Mallal S A, Dawkins R L
Department of Clinical Immunology, Royal Perth Hospital, Western Australia.
AIDS. 1992 Nov;6(11):1293-7. doi: 10.1097/00002030-199211000-00009.
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.
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.
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.
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.
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.
描述在免疫缺陷的HIV感染患者中，齐多夫定治疗开始后，鸟分枝杆菌胞内菌（MAI）局部感染与皮肤对分枝杆菌抗原迟发型超敏反应（DTH）恢复同时出现的情况。
西澳大利亚州首批108例CD4 + T细胞计数<200×10⁶ /L和/或有症状疾病并接受齐多夫定（ZDV）治疗的患者，其中72例有足够的DTH数据。
在开始ZDV治疗前及治疗后6个月内至少两次，通过“多项测试”方法测量对七种抗原的DTH反应。所有患者定期接受复查并记录临床事件。
在开始ZDV治疗前对结核菌素无反应的64例患者中，27例（42%）在接受ZDV治疗后对结核菌素产生了DTH反应。“多项测试”中结核菌素反应≥8mm的9例患者中有4例，以及对鸟分枝杆菌纯化蛋白衍生物结核菌素试验呈阳性的1例患者，在1 - 2周后出现了以局部MAI感染、淋巴结病和/或严重发热为特征的疾病。
免疫缺陷的HIV感染患者在开始ZDV治疗后不久出现局部MAI感染和/或发热，可能反映了部分患者对分枝杆菌抗原细胞免疫的恢复，而非早期治疗失败或对ZDV过敏。
