Association of tuberculosis risk with the degree of tuberculin reaction in HIV-infected patients

Enrico Girardi, Giorgio Antonucci, Giuseppe Ippolito, Mario C. Raviglione, Elisabetta Rapiti, Giovanni Di Perri, Sergio Babudieri, Paolo Almi, Gioacchino Angarano, Orlando Armignacco, Nazario Bevilacqua, Alessandra Bini, Patricia Bottura, Evangelo Boumis, Paolo Costigliola, Isabella Errante, Marco Libanore, Giuseppina Liuzzi, Elio Manzillo, Lorenzo MinoliPasquale Narciso, Gabriella Pagano, Gianpietro Pellizzer, Stefano Rusconi, Domenico Santoro, Eliana Savalli, Marcello Tavio, Antonio Traversa, Pierluigi Viale

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)797-800
Number of pages4
JournalArchives of Internal Medicine
Volume157
Issue number7
Publication statusPublished - 1997

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Tuberculin
Tuberculosis
HIV
Proteins
Confidence Intervals
Public Hospitals
CD4 Lymphocyte Count
Mycobacterium tuberculosis
Immunosuppression
Italy
Multicenter Studies
Communicable Diseases
Cohort Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Girardi, E., Antonucci, G., Ippolito, G., Raviglione, M. C., Rapiti, E., Perri, G. D., ... Viale, P. (1997). Association of tuberculosis risk with the degree of tuberculin reaction in HIV-infected patients. Archives of Internal Medicine, 157(7), 797-800.

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 journalArticle

Girardi, E, Antonucci, G, Ippolito, G, Raviglione, MC, Rapiti, E, Perri, GD, Babudieri, S, Almi, P, Angarano, G, Armignacco, O, Bevilacqua, N, Bini, A, Bottura, P, Boumis, E, Costigliola, P, Errante, I, Libanore, M, Liuzzi, G, Manzillo, E, Minoli, L, Narciso, P, Pagano, G, Pellizzer, G, Rusconi, S, Santoro, D, Savalli, E, Tavio, M, Traversa, A & Viale, P 1997, 'Association of tuberculosis risk with the degree of tuberculin reaction in HIV-infected patients', Archives of Internal Medicine, vol. 157, no. 7, pp. 797-800.
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. / Association of tuberculosis risk with the degree of tuberculin reaction in HIV-infected patients. In: Archives of Internal Medicine. 1997 ; Vol. 157, No. 7. pp. 797-800.
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title = "Association of tuberculosis risk with the degree of tuberculin reaction in HIV-infected patients",
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.",
author = "Enrico Girardi and Giorgio Antonucci and Giuseppe Ippolito and Raviglione, {Mario C.} and Elisabetta Rapiti and Perri, {Giovanni Di} and Sergio Babudieri and Paolo Almi and Gioacchino Angarano and Orlando Armignacco and Nazario Bevilacqua and Alessandra Bini and Patricia Bottura and Evangelo Boumis and Paolo Costigliola and Isabella Errante and Marco Libanore and Giuseppina Liuzzi and Elio Manzillo and Lorenzo Minoli and Pasquale Narciso and Gabriella Pagano and Gianpietro Pellizzer and Stefano Rusconi and Domenico Santoro and Eliana Savalli and Marcello Tavio and Antonio Traversa and Pierluigi Viale",
year = "1997",
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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.

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