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. 1996 Sep;51(9):932–935. doi: 10.1136/thx.51.9.932

Lack of skin test reactivity to common mycobacterial antigens in human immunodeficiency virus infected individuals with high CD4 counts.

S H Khoo 1, E G Wilkins 1, I S Fraser 1, A A Hamour 1, J L Stanford 1
PMCID: PMC472618  PMID: 8984706

Abstract

BACKGROUND: T cell response to mycobacterial antigens may be directed against those antigens common to all mycobacteria (group i), those restricted to slow (group ii) or fast growers (group iii), or those which are species- or subspecies-specific (group iv). These responses were assessed by skin testing patients infected with the human immunodeficiency virus (HIV) and healthy controls with reagents derived from different strains of mycobacteria. METHODS: Skin test responses to new tuberculins prepared from Mycobacterium tuberculosis, M avium serotypes 4 and 8, and either M intracellulare or M flavescens antigens were evaluated prospectively in 51 HIV infected patients and 67 healthy controls. RESULTS: Assessment of induration at 72 hours showed absence of skin test response to common mycobacterial antigens in all 27 HIV positive patients with CD4 counts of > or = 400/mm3 (range 400-1594, median 540) compared with 27% reactivity in controls; complete anergy was demonstrated in 24 patients with CD4 counts of < 400/mm3. By contrast, no difference in species or subspecies-specific responses was found between healthy controls and HIV positive patients with CD4 counts of > or = 400/mm3. CONCLUSIONS: Subsets of CD4+ T helper cells are instrumental in determining the balance between cell-mediated and humoral immunity. One T helper subset (TH1) produces cytokines that increase cellular immunity and is stimulated by group i common mycobacterial antigens. Lack of this response, but preservation of responses to species-specific antigens while CD4 counts are near normal, may indicate an early failing of TH1 immunity and explain the increased susceptibility of HIV positive patients to mycobacterial infection early on in the evolution of their HIV infection.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benson C. A., Ellner J. J. Mycobacterium avium complex infection and AIDS: advances in theory and practice. Clin Infect Dis. 1993 Jul;17(1):7–20. doi: 10.1093/clinids/17.1.7. [DOI] [PubMed] [Google Scholar]
  2. Blatt S. P., Hendrix C. W., Butzin C. A., Freeman T. M., Ward W. W., Hensley R. E., Melcher G. P., Donovan D. J., Boswell R. N. Delayed-type hypersensitivity skin testing predicts progression to AIDS in HIV-infected patients. Ann Intern Med. 1993 Aug 1;119(3):177–184. doi: 10.7326/0003-4819-119-3-199308010-00001. [DOI] [PubMed] [Google Scholar]
  3. Bottasso O. A., Ingledew N., Keni M., Morini J., Pividori J. F., Rook G. A., Stanford J. L. Cellular immune response to common mycobacterial antigens in subjects seropositive for Trypanosoma cruzi. Lancet. 1994 Dec 3;344(8936):1540–1541. doi: 10.1016/s0140-6736(94)90351-4. [DOI] [PubMed] [Google Scholar]
  4. Chin D. P., Hopewell P. C., Yajko D. M., Vittinghoff E., Horsburgh C. R., Jr, Hadley W. K., Stone E. N., Nassos P. S., Ostroff S. M., Jacobson M. A. Mycobacterium avium complex in the respiratory or gastrointestinal tract and the risk of M. avium complex bacteremia in patients with human immunodeficiency virus infection. J Infect Dis. 1994 Feb;169(2):289–295. doi: 10.1093/infdis/169.2.289. [DOI] [PubMed] [Google Scholar]
  5. Clerici M., Shearer G. M. A TH1-->TH2 switch is a critical step in the etiology of HIV infection. Immunol Today. 1993 Mar;14(3):107–111. doi: 10.1016/0167-5699(93)90208-3. [DOI] [PubMed] [Google Scholar]
  6. Horsburgh C. R., Jr Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. N Engl J Med. 1991 May 9;324(19):1332–1338. doi: 10.1056/NEJM199105093241906. [DOI] [PubMed] [Google Scholar]
  7. Lockwood D. N., McManus I. C., Stanford J. L., Thomas A., Abeyagunawardana D. V. Three types of response to mycobacterial antigens. Eur J Respir Dis. 1987 Nov;71(5):348–355. [PubMed] [Google Scholar]
  8. McIntyre G., Belsey E., Stanford J. L. Taxonomic differences between Mycobacterium avium and Mycobacterium intracellulare elucidated in man by skin tests with three new tuberculins. Eur J Respir Dis. 1986 Sep;69(3):146–152. [PubMed] [Google Scholar]
  9. McManus I. C., Lockwood D. N., Stanford J. L., Shaaban M. A., Abdul Ati M., Bahr G. M. Recognition of a category of responders to group II, slow-grower associated antigens amongst Kuwaiti senior school children, using a statistical model. Tubercle. 1988 Dec;69(4):275–281. doi: 10.1016/0041-3879(88)90050-5. [DOI] [PubMed] [Google Scholar]
  10. Rook G. A., al Attiyah R. Cytokines and the Koch phenomenon. Tubercle. 1991 Mar;72(1):13–20. doi: 10.1016/0041-3879(91)90019-o. [DOI] [PubMed] [Google Scholar]
  11. Shield M. J., Stanford J. L., Paul R. C., Carswell J. W. Multiple skin testing of tuberculosis patients with a range of new tuberculins, and a comparison with leprosy and Mycobacterium ulcerans infection. J Hyg (Lond) 1977 Jun;78(3):331–348. doi: 10.1017/s0022172400056230. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Stanford J. L., Grange J. M. The meaning and structure of species as applied to mycobacteria. Tubercle. 1974 Jun;55(2):143–152. doi: 10.1016/0041-3879(74)90008-7. [DOI] [PubMed] [Google Scholar]
  13. Stanford J. L., Onyebujoh P. C., Rook G. A., Grange J. M., Pozniak A. Old plague, new plague, and a treatment for both? AIDS. 1993 Sep;7(9):1275–1277. [PubMed] [Google Scholar]
  14. Tsang A. Y., Denner J. C., Brennan P. J., McClatchy J. K. Clinical and epidemiological importance of typing of Mycobacterium avium complex isolates. J Clin Microbiol. 1992 Feb;30(2):479–484. doi: 10.1128/jcm.30.2.479-484.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. van Eden W., de Vries R. R., Stanford J. L., Rook G. A. HLA-DR3 associated genetic control of response to multiple skin tests with new tuberculins. Clin Exp Immunol. 1983 May;52(2):287–292. [PMC free article] [PubMed] [Google Scholar]
  16. von Reyn C. F., Maslow J. N., Barber T. W., Falkinham J. O., 3rd, Arbeit R. D. Persistent colonisation of potable water as a source of Mycobacterium avium infection in AIDS. Lancet. 1994 May 7;343(8906):1137–1141. doi: 10.1016/s0140-6736(94)90239-9. [DOI] [PubMed] [Google Scholar]
  17. von Reyn C. F., Waddell R. D., Eaton T., Arbeit R. D., Maslow J. N., Barber T. W., Brindle R. J., Gilks C. F., Lumio J., Lähdevirta J. Isolation of Mycobacterium avium complex from water in the United States, Finland, Zaire, and Kenya. J Clin Microbiol. 1993 Dec;31(12):3227–3230. doi: 10.1128/jcm.31.12.3227-3230.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]

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