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Tine testing in HIV positive patients

S P Higgins1, C S Bradbeer, N T Bateman

  • 1Department of Genitourinary Medicine, St Thomas' Hospital, London.

Thorax
|August 1, 1993
PubMed
Summary

Purified protein derivative (PPD) testing in HIV-positive patients showed reactivity can be maintained even with low CD4+ counts, especially with a history of tuberculosis or BCG immunization. This suggests PPD testing remains a useful diagnostic tool in this population.

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Area of Science:

  • Immunology
  • Infectious Diseases
  • Public Health

Background:

  • HIV infection significantly increases tuberculosis (TB) risk.
  • Routine Purified Protein Derivative (PPD) testing for TB diagnosis in HIV-positive individuals in the UK is not standard practice.
  • The diagnostic utility of PPD testing in HIV-positive patients remains uncertain.

Purpose of the Study:

  • To evaluate the effectiveness of Purified Protein Derivative (PPD) testing for diagnosing tuberculosis in HIV-positive patients.
  • To assess the correlation between PPD reactivity and CD4+ lymphocyte counts in this population.
  • To determine if PPD testing remains a viable diagnostic tool for tuberculosis in individuals with HIV.

Main Methods:

  • 198 HIV-positive patients underwent Tine testing for PPD reactivity.
  • CD4+ lymphocyte counts and chest radiographs were performed for all participants.
  • Patients self-assessed skin reactions at 72 hours, with a second test offered for non-reactive (Grade 0) results.

Main Results:

  • Data was available for 168 out of 198 patients.
  • Low-grade PPD reactivity was observed in 18 patients with CD4+ counts below 200/mm3 on the first test, and nine on a second test.
  • Two patients with recent TB treatment and very low CD4+ counts (60/mm3 and 4/mm3) were PPD positive.

Conclusions:

  • PPD reactivity can persist in HIV-positive individuals even with CD4+ counts as low as 100/mm3 or less.
  • A history of tuberculosis or BCG immunization appears to maintain PPD reactivity.
  • PPD testing may retain diagnostic value for tuberculosis in HIV-positive patients, particularly those with a relevant history.

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