The clinical utility of measuring cutaneous delayed-type hypersensitivity (DTH) responses in HIV-infected patients
French, M.A.H. and Mallal, S. (1996) The clinical utility of measuring cutaneous delayed-type hypersensitivity (DTH) responses in HIV-infected patients. In: XI International Conference on AIDS, 7 - 12 July 1996, Vancouver, Canada
Aim: To determine the value of and indications for measuring cutaneous DTH responses to evaluate cellular immune function in HIV-infected patients. Methods: Data on DTH responses, CD4 T-cell percentages and opportunistic infections (OIs) were analysed from patients in the Western Australian HIV Cohort Study (WAHCS) database. DTH responses were measured using the Multitest CMI method and results expressed as a Multitest score. Results: Multitest scores declined progressively in all patients who developed AIDS with the greatest decline commencing at about 20-25% CD4 T-cells. By multivariate analysis DTH had prognostic value in predicting the time to both AIDS and death independantly of %CD4 T-cells, particularly in patients with 10-19% CD4 T-cells RH=0.728 per 5mm for both, p=0.002 and 0.004 respectively). Furthermore, patients with a Multitest score of greater than 5 n=127) at the time of first reaching less than 20% CD4 T-cells, had a median survival of 70.7 months compared with 36.5 months in patients with a Multitest score of less than 5 (n=83) [p=0.0016, log rank test]. Measurement of Multi-test scores in 68 patients at or within the 50 days prior to developing an OI demonstrated that 73% of 41 patients with pneumocystis pneumonia (PCP) were anergic, including 3 with greater than 20% and 5 with 10-20% CD4 T-cells. All but one of the other PCP patients has a Multitest score of less than 5. Multi-test scores in patients with greater than 10% CD4 T-cells who developed PCP were significantly lower than in randomly selected patients matched for %CD4 T-cells who had never had an OI (p is less than 0.05, Mann-Whitney). In patients with OIs other than PCP (n=27), 89% had Multitest scores of less than 5 but all except one, who had tuberculosis, also had less than 10% CD4 T-cells. Conclusion: Measurement of DTH responses has additional value to quantitation of CD4 T-cells in determining (a) the prognosis of HIV-infected patients1, and (b) the susceptibility of patients to PCP, especially patients with 10-20% CD4 T-cells, as well as having clinical utility in demonstrating restoration of cell-mediated immunity (CMI) by zidovudine2, including CMI to pathogenic mycobacteria3,4.
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