Document 0611
 DOCN  M95A0611
 TI    Delayed type hypersensitivity (DTH) skin testing in HIV infected (HIV+)
       children. American Pediatric Society 104th annual meeting and Society
       for Pediatric Research 63rd annual meeting; 1994 May 2-5; Seattle.
 DT    9510
 AU    Raszka WV; Moriarty RA; Waecker NJ; Ascher DP; Ottolini MG; Cieslak TS;
       Birx D; Robb ML; Department of Pediatrics WBAMC, El Paso, TX, USA.
 SO    Pediatr AIDS HIV Infect. 1994 Oct;5(5):320 (unnumbered abstract). Unique
       Identifier : AIDSLINE AIDS/95330433
 AB    BACKGROUND: Although DTH skin testing to recall antigens has been used
       to clinically stage adults with HIV disease, little is known about the
       ability of HIV+ children to mount an immune response to intradermally
       placed antigen. METHODS: The DTH responses of HIV+ children who survived
       the first year of life were prospectively evaluated. On a yearly basis,
       0.1 cc volumes of 6 of 7 antigens were intradermally injected on the
       patient's forearms and the mean diameter of the induration at 48 hours
       measured. Antigens tested included dilutions of stock concentrations of
       PPD (5 TU), mumps ST (1:20), tetanus toxoid (1:10 and 1:100),
       trichophyton (1:30), and C albicans (1:10 and 1:100). Patients were
       considered anergic if they had no response and partially anergic if they
       had only one cutaneous response greater than 4 mm to any antigen.
       RESULTS: 61 DTH panels from 26 ethnically diverse, appropriately
       immunized patients (16 male) were evaluated. Mean age of the patients
       during the study was 84 months (range 8.5-156). Risk factors for HIV
       infection included perinatal exposure (16), hemophilia (8), and
       transfusion (2). Patients were asymptomatic (1987 CDC stage P1) during
       42/61 DTH determinations. Patients demonstrated DTH responses to all
       antigens tested except PPD. No adverse reactions were noted. Tetanus
       toxoid (1:100) and trichophyton had the fewest number of responses
       (10/46 and 17/59) and the smallest mean size of induration in responders
       (8.0 and 8.5 mm). Mumps and C. albicans (1:10) had the greatest number
       of reactions (44/61 and 39/50) and the largest mean size of induration
       in responders (11.4 and 16.9 mm). Only 2/42 asymptomatic patients
       demonstrated complete anergy compared to 5/19 symptomatic patients (p <
       0.02) Median CD4% in anergic patients was 8% (range 1-22) compared to
       28% (4-55) in patients with normal DTH responses (p < 0.01). While
       anergy was associated with low CD4%, 9/19 patients were normal or
       partially anergic despite CD4% less than than 20%. CONCLUSIONS: HIV+
       children reported here exhibited appropriate cellular immune responses
       for a longer duration of time than in previously reported cohorts.
       Normal DTH responses can persist despite low CD4%. DTH reactions may be
       useful as a predictor of disease progression in HIV+ pediatric patients.
 DE    Candida albicans/IMMUNOLOGY  Child  Child, Preschool  CD4 Lymphocyte
       Count  Female  Human  Hypersensitivity, Delayed/COMPLICATIONS/*DIAGNOSIS
       HIV Infections/*IMMUNOLOGY  Infant  *Intradermal Tests  Male  Mumps
       Virus/IMMUNOLOGY  Prospective Studies  Tetanus Toxoid/IMMUNOLOGY
       Trichophyton/IMMUNOLOGY  Tuberculin Test  MEETING ABSTRACT  JOURNAL
       ARTICLE

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