Correlation between CD4+ lymphocyte counts, concurrent antigen skin test and tuberculin skin test reactivity in human immunodeficiency virus type 1-infected and -uninfected children with tuberculosis

Background HIV-infected children are at high risk of developing tuberculosis after infection by Mycobacterium tuberculosis. Emphasis is placed on tuberculin skin testing (TST) for diagnosing tuberculosis in children; however, its value in HIV-infected children is controversial. Objectives. To determine whether concurrent antigen testing and/or CD4(+) lymphocyte counts help in the interpretation of the TST in children with tuberculosis. Methods. Children eligible for the study were diagnosed as having tuberculosis on clinical criteria. CD4(+) lymphocyte counts and delayed-type hypersensitivity (DTH) test, using the CMI Multitest were performed when tuberculosis was diagnosed. Results. One hundred thirty children were enrolled. Tuberculin reactivity was lower in HIV-infected children at all cutoff levels than in HIV-uninfected children (P < 0.0001). The positive predictive value of normal CD4(+) lymphocyte counts in predicting tuberculin reactions of greater than or equal to 5 mm tin HIV-1-infected) and greater than or equal to 10 mm tin HIV-uninfected patients) were 50 and 80.3%, respectively (P < 0.0001). An intact DTH reaction to the CMI Multitest in predicting reactions of greater than or equal to 5 mm and greater than or equal to 10 mm to tuberculin in HIV-infected and -uninfected children were 55 and 76%, respectively (P < 0.001). Kwashiorkor was responsible for 53.3% of false-negative TST in HIV-uninfected children with normal CD4(+) lymphocyte counts, Conclusion. TST is of limited value as an adjunct in diagnosing tuberculosis in HIV-infected children. CD4(+) lymphocyte counts and concurrent DTH testing are not useful for predicting tuberculin reactivity in HIV-infected patients with tuberculosis.