Delayed-type hypersensitivity skin tests are an independent predictor of human immunodeficiency virus disease progression

Abstract

Delayed-type hypersensitivity (DTH) testing was evaluated as a predictor of human immunodeficiency virus (HIV) disease progression in 336 symptomatic patients with baseline CD4 cell counts of 200-500/mm3 who were participating in a randomized trial ofearly versus late therapy with zidovudine. Patients with a response of >2 mm to any of seven antigens were categorized as reactive; those without were anergic. Anergic patients were significantly more likely than reactive patients to have HIV disease progression as evidenced by decrease in CD4 cell count (52% vs. 27%), development ofAIDS (33% vs. 17%), or death (18% vs. 9%) (P ≤.02), irrespective oftime of zidovudine initiation. By multivariate analysis, DTH results were an independent predictor of HIV progression separate from CD4 cell count, p24 antigen positivity, or level ofPrmicroglobulin. DTH skin tests are an independent predictor of HIV disease progression and may be ofvalue in the evaluation of a patient's immune status. © 1994 by The University of Chicago.