Abstract
Background: The risk of developing active tuberculosis associated with a different size of induration to purified protein derivative (PPD) has not been prospectively assessed among individuals infected with human immunodeficiency virus (HIV). The quantification of this risk is important to more appropriately identify candidates for preventive therapy for tuberculosis. Methods: A prospective, multicenter, cohort study on tuberculosis in HIV-infected patients was conducted in 23 infectious disease units in public hospitals in Italy. Two thousand six hundred ninety-five HIV- infected patients were enrolled in the study. Of these, 1054 patients who were nonanergic at the time of entry were included in the present analysis. The median duration of follow-up was 102 weeks. The main outcome measure was a diagnosis of active tuberculosis confirmed by the isolation of Mycobacterium tuberculosis in culture. Results: Among the 252 patients with PPD reactivity, patients with an induration to PPD of 2 to 4 mm had a median CD4 + lymphocyte count of 0.34 x 10 9/L (interquartile [IQ] range, 0.14 x 10 9-0.56 x 10 9), those with a response of 5 to 9 mm had a median count of 0.38 x 10 9/L (IQ range, 0.24 x 10 9-0.56 x 10 9), and those with a response of 10 mm or higher had a median count of 0.37 x 10 9/L (IQ range, 0.23 x 10 9-0.52 x 10 9) (P=.38). Compared with the 802 nonanergic PPD-negative patients, hazard ratios of tuberculosis were 2.1 (95% confidence interval [CI], 0.2-18.3) among the 55 patients with a response to PPD of 2 to 4 mm, 5.7 (95% CI, 1.6-19.8) among the 128 patients with a response to PPD of 5 to 9 mm, and 23.1 (95% CI, 7.8-68.6) among the 69 patients with a response to PPD of 10 mm or higher. Conclusions: Among nonanergic HIV-infected patients, the degree of response to tuberculin does not appear to reflect the degree of immunosuppression and is strongly correlated with the subsequent incidence of tuberculosis. To identify HIV-infected patients who are at an increased risk of tuberculosis and may benefit from preventive therapy, a response to PPD of 5 mm appears to be an appropriate cutoff point.
| Original language | English |
|---|---|
| Pages (from-to) | 797-800 |
| Number of pages | 4 |
| Journal | Archives of Internal Medicine |
| Volume | 157 |
| Issue number | 7 |
| Publication status | Published - 1997 |
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Association of tuberculosis risk with the degree of tuberculin reaction in HIV-infected patients. / Girardi, Enrico; Antonucci, Giorgio; Ippolito, Giuseppe; Raviglione, Mario C.; Rapiti, Elisabetta; Perri, Giovanni Di; Babudieri, Sergio; Almi, Paolo; Angarano, Gioacchino; Armignacco, Orlando; Bevilacqua, Nazario; Bini, Alessandra; Bottura, Patricia; Boumis, Evangelo; Costigliola, Paolo; Errante, Isabella; Libanore, Marco; Liuzzi, Giuseppina; Manzillo, Elio; Minoli, Lorenzo; Narciso, Pasquale; Pagano, Gabriella; Pellizzer, Gianpietro; Rusconi, Stefano; Santoro, Domenico; Savalli, Eliana; Tavio, Marcello; Traversa, Antonio; Viale, Pierluigi.
In: Archives of Internal Medicine, Vol. 157, No. 7, 1997, p. 797-800.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Association of tuberculosis risk with the degree of tuberculin reaction in HIV-infected patients
AU - Girardi, Enrico
AU - Antonucci, Giorgio
AU - Ippolito, Giuseppe
AU - Raviglione, Mario C.
AU - Rapiti, Elisabetta
AU - Perri, Giovanni Di
AU - Babudieri, Sergio
AU - Almi, Paolo
AU - Angarano, Gioacchino
AU - Armignacco, Orlando
AU - Bevilacqua, Nazario
AU - Bini, Alessandra
AU - Bottura, Patricia
AU - Boumis, Evangelo
AU - Costigliola, Paolo
AU - Errante, Isabella
AU - Libanore, Marco
AU - Liuzzi, Giuseppina
AU - Manzillo, Elio
AU - Minoli, Lorenzo
AU - Narciso, Pasquale
AU - Pagano, Gabriella
AU - Pellizzer, Gianpietro
AU - Rusconi, Stefano
AU - Santoro, Domenico
AU - Savalli, Eliana
AU - Tavio, Marcello
AU - Traversa, Antonio
AU - Viale, Pierluigi
PY - 1997
Y1 - 1997
N2 - Background: The risk of developing active tuberculosis associated with a different size of induration to purified protein derivative (PPD) has not been prospectively assessed among individuals infected with human immunodeficiency virus (HIV). The quantification of this risk is important to more appropriately identify candidates for preventive therapy for tuberculosis. Methods: A prospective, multicenter, cohort study on tuberculosis in HIV-infected patients was conducted in 23 infectious disease units in public hospitals in Italy. Two thousand six hundred ninety-five HIV- infected patients were enrolled in the study. Of these, 1054 patients who were nonanergic at the time of entry were included in the present analysis. The median duration of follow-up was 102 weeks. The main outcome measure was a diagnosis of active tuberculosis confirmed by the isolation of Mycobacterium tuberculosis in culture. Results: Among the 252 patients with PPD reactivity, patients with an induration to PPD of 2 to 4 mm had a median CD4 + lymphocyte count of 0.34 x 10 9/L (interquartile [IQ] range, 0.14 x 10 9-0.56 x 10 9), those with a response of 5 to 9 mm had a median count of 0.38 x 10 9/L (IQ range, 0.24 x 10 9-0.56 x 10 9), and those with a response of 10 mm or higher had a median count of 0.37 x 10 9/L (IQ range, 0.23 x 10 9-0.52 x 10 9) (P=.38). Compared with the 802 nonanergic PPD-negative patients, hazard ratios of tuberculosis were 2.1 (95% confidence interval [CI], 0.2-18.3) among the 55 patients with a response to PPD of 2 to 4 mm, 5.7 (95% CI, 1.6-19.8) among the 128 patients with a response to PPD of 5 to 9 mm, and 23.1 (95% CI, 7.8-68.6) among the 69 patients with a response to PPD of 10 mm or higher. Conclusions: Among nonanergic HIV-infected patients, the degree of response to tuberculin does not appear to reflect the degree of immunosuppression and is strongly correlated with the subsequent incidence of tuberculosis. To identify HIV-infected patients who are at an increased risk of tuberculosis and may benefit from preventive therapy, a response to PPD of 5 mm appears to be an appropriate cutoff point.
AB - Background: The risk of developing active tuberculosis associated with a different size of induration to purified protein derivative (PPD) has not been prospectively assessed among individuals infected with human immunodeficiency virus (HIV). The quantification of this risk is important to more appropriately identify candidates for preventive therapy for tuberculosis. Methods: A prospective, multicenter, cohort study on tuberculosis in HIV-infected patients was conducted in 23 infectious disease units in public hospitals in Italy. Two thousand six hundred ninety-five HIV- infected patients were enrolled in the study. Of these, 1054 patients who were nonanergic at the time of entry were included in the present analysis. The median duration of follow-up was 102 weeks. The main outcome measure was a diagnosis of active tuberculosis confirmed by the isolation of Mycobacterium tuberculosis in culture. Results: Among the 252 patients with PPD reactivity, patients with an induration to PPD of 2 to 4 mm had a median CD4 + lymphocyte count of 0.34 x 10 9/L (interquartile [IQ] range, 0.14 x 10 9-0.56 x 10 9), those with a response of 5 to 9 mm had a median count of 0.38 x 10 9/L (IQ range, 0.24 x 10 9-0.56 x 10 9), and those with a response of 10 mm or higher had a median count of 0.37 x 10 9/L (IQ range, 0.23 x 10 9-0.52 x 10 9) (P=.38). Compared with the 802 nonanergic PPD-negative patients, hazard ratios of tuberculosis were 2.1 (95% confidence interval [CI], 0.2-18.3) among the 55 patients with a response to PPD of 2 to 4 mm, 5.7 (95% CI, 1.6-19.8) among the 128 patients with a response to PPD of 5 to 9 mm, and 23.1 (95% CI, 7.8-68.6) among the 69 patients with a response to PPD of 10 mm or higher. Conclusions: Among nonanergic HIV-infected patients, the degree of response to tuberculin does not appear to reflect the degree of immunosuppression and is strongly correlated with the subsequent incidence of tuberculosis. To identify HIV-infected patients who are at an increased risk of tuberculosis and may benefit from preventive therapy, a response to PPD of 5 mm appears to be an appropriate cutoff point.
UR - http://www.scopus.com/inward/record.url?scp=0030901216&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030901216&partnerID=8YFLogxK
M3 - Article
C2 - 9125013
AN - SCOPUS:0030901216
VL - 157
SP - 797
EP - 800
JO - Archives of Internal Medicine
JF - Archives of Internal Medicine
SN - 0003-9926
IS - 7
ER -