Raszka W V, Moriarty R A, Ottolini M G, Waecker N J, Ascher D P, Cieslak T J, Fischer G W, Robb M L
Department of Pediatrics, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.
J Pediatr. 1996 Aug;129(2):245-50. doi: 10.1016/s0022-3476(96)70249-4.
To evaluate whether pediatric patients infected with human immunodeficiency virus (HIV) can mount appropriate delayed-type hypersensitivity (DTH) skin responses to recall antigens and whether these responses can be correlated with clinical or immunologic parameters.
Prospective evaluation of DTH responses in HIV-infected children. Uninfected children born to HIV-infected mothers served as control subjects. Antigens used for yearly DTH testing included Candida albicans (1:100, 1:10); mumps virus; Trichophyton; purified protein derivative of tuberculin; and tetanus toxoid (1:100, 1:10). At the time of each DTH test, patients were staged according to two Centers for Disease Control and Prevention pediatric HIV classification systems, and T-cell subsets were obtained.
Twenty-seven HIV-infected patients with a median age at entry of 74.1 (range, 12 to 156) months were followed. Forty-four DTH skin tests in 21 symptom-free HIV-infected patients (PI) and 18 tests in 10 HIV-infected patients with symptoms (P2), as well as 43 DTH skin tests in 18 patients who had either mild or moderate clinical symptoms or immunosuppression and 19 tests in 13 patients with severe symptoms or immunosuppression, were evaluated. Sixteen DTH skin tests were performed in 14 uninfected patients. HIV-infected patients tended to have fewer DTH responses to antigens and of smaller size than did uninfected patients. When controlled for age, few differences in DTH responsiveness were seen between HIV-infected and uninfected patients. Anergy was associated with symptomatic disease, evidence of advanced clinical or immunologic disease, and low CD4+ percentages (p <0.05).
HIV-infected children are able to mount antigen-specific cell-mediated immune responses that are qualitatively similar to those of age-matched control subjects. Loss of DTH responsiveness correlates with both clinical and immunologic evidence of HIV disease progression.
评估感染人类免疫缺陷病毒（HIV）的儿科患者是否能对回忆抗原产生适当的迟发型超敏反应（DTH）皮肤反应，以及这些反应是否与临床或免疫参数相关。
对HIV感染儿童的DTH反应进行前瞻性评估。感染HIV母亲所生的未感染儿童作为对照。每年用于DTH检测的抗原包括白色念珠菌（1:100，1:10）；腮腺炎病毒；毛癣菌；结核菌素纯蛋白衍生物；以及破伤风类毒素（1:100，1:10）。每次DTH检测时，根据两个美国疾病控制与预防中心的儿科HIV分类系统对患者进行分期，并获取T细胞亚群。
对27例HIV感染患者进行了随访，入组时的中位年龄为74.1（范围12至156）个月。对21例无症状HIV感染患者（PI）进行了44次DTH皮肤试验，对10例有症状的HIV感染患者（P2）进行了18次试验，对18例有轻度或中度临床症状或免疫抑制的患者进行了43次DTH皮肤试验，对13例有严重症状或免疫抑制的患者进行了19次试验。对14例未感染患者进行了16次DTH皮肤试验。与未感染患者相比，HIV感染患者对抗原的DTH反应往往较少且反应面积较小。在控制年龄后，HIV感染患者和未感染患者在DTH反应性方面几乎没有差异。无反应性与有症状疾病、晚期临床或免疫疾病证据以及低CD4 +百分比相关（p<0.05）。
HIV感染儿童能够产生与年龄匹配的对照受试者在质量上相似的抗原特异性细胞介导免疫反应。DTH反应性的丧失与HIV疾病进展的临床和免疫证据相关。
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