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• W1970060552 abstract "Communications for this section will be published as space and priorities permit The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments or articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. To the Editor: “The tuberculin skin test has been the traditional method of diagnosing infection with mycobacterium tuberculosis … no better diagnostic methods have yet been devised.”1ATS The tuberculin skin test..Am Rev Respir Dis. 1981; 124: 356-363Google Scholar “Screening for tuberculosis has relied upon the tuberculin skin test, and the emphasis in screening has shifted to finding those who are at risk of developing disease and infecting others as well as detecting those who already have disease. The tuberculin skin test is the preferred initial method of screening.”2ATS Control of tuberculosis..Am Rev Respir Dis. 1983; 128: 336-342Google Scholar “In recent years, reported tuberculosis cases in New York City have increased substantially in large part related to coexisting human immunodeficiency virus (HIV) and mycobacterium tuberculosis infection … data suggest that HIV infection in the absense of AIDS is associated with increased TB morbidity … most tuberculosis in patients with AIDS results from reactivation of a previously acquired latent infection.”3CDC Tuberculosis and acquired immunodeficiency syndrome. New York City.MMWR. 1987; 36: 785-795PubMed Google Scholar “In certain high risk areas for AIDS, the number and proportion of cases of tuberculosis relation to occult HIV immunosuppression may be large, and this may be of major importance with respect to the clinical presentation and control of tuberculosis.”4Pitchenik AE et al.Human T-cell lymphototropic virus III (HTLV-III). Seropositivity and related disease amont 71 consecutive patients in whom tuberculosis was diagnosed. A prospective study.Am Rev Respir Dis. 1987; 135: 875-879Crossref PubMed Scopus (130) Google Scholar “Since tuberculosis is transmissible, treatable, and possibly preventable … tuberculosis must be considered in dealing with intravenous drug abusers or Haitians with AIDS so that diagnosis can be made”5Sunderam G et al.Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS)..JAMA. 1986; 256: 362-366Crossref PubMed Scopus (333) Google Scholar and transmission to healthy subjects prevented. A higher than normal rate of falsely negative tuberculin skin test was recorded not only in patients with AIDS,3CDC Tuberculosis and acquired immunodeficiency syndrome. New York City.MMWR. 1987; 36: 785-795PubMed Google Scholar but also in HIV seropositive subjects with concomitant tuberculosis.4Pitchenik AE et al.Human T-cell lymphototropic virus III (HTLV-III). Seropositivity and related disease amont 71 consecutive patients in whom tuberculosis was diagnosed. A prospective study.Am Rev Respir Dis. 1987; 135: 875-879Crossref PubMed Scopus (130) Google Scholar “An immediate problem is to assess the validity of tuberculin skin test results in persons with tuberculosis infection and HIV infection.”6Topics in Pulmonary Medicine Symposium Mycobacterial disease in AIDS. Chairman: R.J. O'Brien.Am Rev Respir Dis. 1987; 136: 1027-1030Google Scholar We studied a group of prisoners as they have a substantially higher risk of being anti-HIV carriers than the general population. In prisons, considerable numbers of intravenous drug users (a high proportion of whom are probably HIV carriers) can be expected to have occasional homosexual contacts. We performed tuberculin skin test (PPD Sclavo 5 TU) and chest x-ray in 143 subjects (127 men and 16 women) on two consecutive days. HIV serologic tests (Abbot and Sorin enzyme immunoassays as first screening test; positivity was confirmed by Western Elot, DuPont) and determination of lymphocytes subsets in HIV seropositive subjects (Ortho monoclonal antibodies and cytofluorimeter Epics/c) had already been performed. All the subjects were examined by a physician (history and physical examination) and underwent a serologic study for anti-HIV antibodies when admitted in prison. Then a specialist in infectious diseases took care of all HIV seropositive prisoners. The tuberculin skin test was read by a specialist in pulmonary medicine unaware of the HIV test results. A tuberculin skin test was considered to be reactive with an induration larger than 5 mm. Subjects were divided into two groups (reactive or non-reactive) according to this threshold for statistical analysis. In Italy there is no clinico-epidemiologic reason to consider a 6 to 10 mm reaction of uncertain significance owing to the rarity of non-tuberculous mycobacterial infections. We found 52 HIV seropositive subjects, 43 of whom were symptomless and included in the study. The control group was 65 HIV seronegative prisoners of the same age. Chest x-ray film showed no pleuro-pulmonary lesion in any subject. The results are summarized in the table. Our data show a significant difference as 28 HIV seronegative (43 percent) but only four HIV seropositive (9 percent) patients were reactive to PPD T-helper cell counts for the four HIV seropositive reactive subjects were 763, 380, 348, and 517 × cu mm. There is no epidemiologic reason to suppose a real inferior incidence of tuberculous infection in HIV seropositive patients. Indeed, intravenous drug users have a high incidence of tuberculosis infection.7Reichman LB Felton CP Edsall JR Drug dependence, a possible new risk factor for tuberculosis disease..Arch Intern Med. 1979; 189: 337-339Crossref Scopus (146) Google Scholar We found a significant decrease of T-helper lymphocytes in our subjects; this may be the cause of a falsely-negative tuberculin skin test result in asymptomatic HIV seropositive people. We conclude that: 1) this test cannot be confidently used in asymptomatic HIV seropositive subjects (with a T-helper lymphocyte count decrease) as screening test for tuberculosis control; 2) HIV seropositivity should be included in the list of causes of falsely negative tuberculin skin test; and 3) tuberculin skin test negativity has to be evaluated more carefully for tuberculosis control owing to the growing incidence of symptomless HIV seropositive persons in the general population." @default.
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• W1970060552 title "Tuberculin Skin Test in Asymptomatic HIV Seropositive Carriers" @default.
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