Delayed-type hypersensitivity, in vitro T-cell responsiveness and risk of active coccidioidomycosis among HIV-infected patients living in the coccidioidal endemic area

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Abstract

The prognostic importance of specific and general tests of immune function were examined among a cohort of 170 subjects infected with human immunodeficiency virus type-1 (HIV), living in an area endemic for the fungal infection coccidioidomycosis. Using the proportional hazards model and multivariate analysis, lack of expression of coccidioidal delayed-type hypersensitivity (DTH) was found to be dependent on anergy in response to the non-coccidioidal antigens mumps, Trichophyton and Candida (relative hazard 4.2, 95% CI 1.8-9.8, P = 0.001). Among subjects with CD4 lymphocyte counts ≥ 250 μl-1 on entry into the study, the in vitro lymphocyte transformation (LT) response to the coccidioidal antigen toluene spherule lysate was 4967 ± 1652 (mean counts per minute (c.p.m.) ± SEM) in subjects with coccidioidal DTH compared with 136 ± 222 in those with negative DTH (P < 0.001). However, amongst those whose CD4 count was < 250 μl-1, LT responses were low and there was no significant difference based on coccidioidal DTH (P = 0.965). Using the proportional hazards model and multivariate analysis, only a CD4 count < 250 μl-1 was prognostically associated with the development of either active coccidioidomycosis or AIDS. These data indicate that immunodeficiency, particularly a CD4 lymphocyte count < 250 μl-1, is the most important factor in the lack of expression of specific immunity to coccidioidomycosis and in the development of active coccidioidomycosis among HIV-infected individuals living in the coccidioidal endemic area.

Original languageEnglish (US)
Pages (from-to)245-250
Number of pages6
JournalMedical Mycology
Volume37
Issue number4
DOIs
StatePublished - Aug 1999

Fingerprint

coccidioidomycosis
Coccidioidomycosis
delayed hypersensitivity
Delayed Hypersensitivity
CD4 Lymphocyte Count
Human immunodeficiency virus 1
HIV-1
T-lymphocytes
T-Lymphocytes
lymphocyte count
lymphocyte proliferation
Lymphocyte Activation
Proportional Hazards Models
multivariate analysis
Multivariate Analysis
antigens
Antigens
Trichophyton
Mumps
Mycoses

Keywords

  • Coccidioidomycosis
  • Delayed-type hypersensitivity
  • HIV
  • In vitro lymphocyte responsiveness

ASJC Scopus subject areas

  • Agricultural and Biological Sciences (miscellaneous)
  • veterinary(all)
  • Microbiology

Cite this

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title = "Delayed-type hypersensitivity, in vitro T-cell responsiveness and risk of active coccidioidomycosis among HIV-infected patients living in the coccidioidal endemic area",
abstract = "The prognostic importance of specific and general tests of immune function were examined among a cohort of 170 subjects infected with human immunodeficiency virus type-1 (HIV), living in an area endemic for the fungal infection coccidioidomycosis. Using the proportional hazards model and multivariate analysis, lack of expression of coccidioidal delayed-type hypersensitivity (DTH) was found to be dependent on anergy in response to the non-coccidioidal antigens mumps, Trichophyton and Candida (relative hazard 4.2, 95{\%} CI 1.8-9.8, P = 0.001). Among subjects with CD4 lymphocyte counts ≥ 250 μl-1 on entry into the study, the in vitro lymphocyte transformation (LT) response to the coccidioidal antigen toluene spherule lysate was 4967 ± 1652 (mean counts per minute (c.p.m.) ± SEM) in subjects with coccidioidal DTH compared with 136 ± 222 in those with negative DTH (P < 0.001). However, amongst those whose CD4 count was < 250 μl-1, LT responses were low and there was no significant difference based on coccidioidal DTH (P = 0.965). Using the proportional hazards model and multivariate analysis, only a CD4 count < 250 μl-1 was prognostically associated with the development of either active coccidioidomycosis or AIDS. These data indicate that immunodeficiency, particularly a CD4 lymphocyte count < 250 μl-1, is the most important factor in the lack of expression of specific immunity to coccidioidomycosis and in the development of active coccidioidomycosis among HIV-infected individuals living in the coccidioidal endemic area.",
keywords = "Coccidioidomycosis, Delayed-type hypersensitivity, HIV, In vitro lymphocyte responsiveness",
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N2 - The prognostic importance of specific and general tests of immune function were examined among a cohort of 170 subjects infected with human immunodeficiency virus type-1 (HIV), living in an area endemic for the fungal infection coccidioidomycosis. Using the proportional hazards model and multivariate analysis, lack of expression of coccidioidal delayed-type hypersensitivity (DTH) was found to be dependent on anergy in response to the non-coccidioidal antigens mumps, Trichophyton and Candida (relative hazard 4.2, 95% CI 1.8-9.8, P = 0.001). Among subjects with CD4 lymphocyte counts ≥ 250 μl-1 on entry into the study, the in vitro lymphocyte transformation (LT) response to the coccidioidal antigen toluene spherule lysate was 4967 ± 1652 (mean counts per minute (c.p.m.) ± SEM) in subjects with coccidioidal DTH compared with 136 ± 222 in those with negative DTH (P < 0.001). However, amongst those whose CD4 count was < 250 μl-1, LT responses were low and there was no significant difference based on coccidioidal DTH (P = 0.965). Using the proportional hazards model and multivariate analysis, only a CD4 count < 250 μl-1 was prognostically associated with the development of either active coccidioidomycosis or AIDS. These data indicate that immunodeficiency, particularly a CD4 lymphocyte count < 250 μl-1, is the most important factor in the lack of expression of specific immunity to coccidioidomycosis and in the development of active coccidioidomycosis among HIV-infected individuals living in the coccidioidal endemic area.

AB - The prognostic importance of specific and general tests of immune function were examined among a cohort of 170 subjects infected with human immunodeficiency virus type-1 (HIV), living in an area endemic for the fungal infection coccidioidomycosis. Using the proportional hazards model and multivariate analysis, lack of expression of coccidioidal delayed-type hypersensitivity (DTH) was found to be dependent on anergy in response to the non-coccidioidal antigens mumps, Trichophyton and Candida (relative hazard 4.2, 95% CI 1.8-9.8, P = 0.001). Among subjects with CD4 lymphocyte counts ≥ 250 μl-1 on entry into the study, the in vitro lymphocyte transformation (LT) response to the coccidioidal antigen toluene spherule lysate was 4967 ± 1652 (mean counts per minute (c.p.m.) ± SEM) in subjects with coccidioidal DTH compared with 136 ± 222 in those with negative DTH (P < 0.001). However, amongst those whose CD4 count was < 250 μl-1, LT responses were low and there was no significant difference based on coccidioidal DTH (P = 0.965). Using the proportional hazards model and multivariate analysis, only a CD4 count < 250 μl-1 was prognostically associated with the development of either active coccidioidomycosis or AIDS. These data indicate that immunodeficiency, particularly a CD4 lymphocyte count < 250 μl-1, is the most important factor in the lack of expression of specific immunity to coccidioidomycosis and in the development of active coccidioidomycosis among HIV-infected individuals living in the coccidioidal endemic area.

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