{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:11:01Z","timestamp":1774620661388,"version":"3.50.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[1998,12,1]],"date-time":"1998-12-01T00:00:00Z","timestamp":912470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Anergy testing has been used as an adjunct to tuberculin testing for assessing M. tuberculosis (MTB) infection and indications for isoniazid preventive therapy in HIV-infected persons. We examined factors associated with the stability of skin test responses to purified protein derivative (PPD) and candida antigens in a cohort of HIV-infected adults followed prospectively in a tuberculosis preventive therapy trial in Uganda. PPD-positive and anergic subjects in the placebo arms of the preventive therapy study underwent repeat skin testing and immunologic testing including measurement of MTB culture filtrate (CF)\u2013stimulated interferon gamma (IFN- \u03b3 ) and tumor necrosis factor alpha (TNF- \u03b1 ) levels in whole-blood culture supernatants. Anergy was present in 27% of 4,058 HIV-infected subjects screened for the tuberculosis preventive therapy trial compared with 10% of 682 HIV-non-infected persons. On follow-up testing of enrolled subjects, 42% of 139 initially anergic subjects were no longer anergic; two thirds of these had PPD reactions \u2265 5 mm. Stability of anergy was associated with intercurrent opportunistic infections and AIDS-associated dermatitis at baseline. Thirty-five percent of 313 subjects with an initial positive PPD had a negative PPD test at follow-up, 26% of whom had a positive candida skin test at the same time as the negative PPD test. Baseline MTBCF-stimulated IFN- \u03b3 levels were significantly higher among PPD-positive subjects who remained PPD-positive than in those who were falsely negative. We conclude first that anergy is unstable and second that anergy testing is unreliable in identifying HIV-infected adults who are not infected with MTB and should not be used routinely for this purpose in assessing indications for isoniazid preventive therapy.<\/jats:p>","DOI":"10.1164\/ajrccm.158.6.9803104","type":"journal-article","created":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T13:51:12Z","timestamp":1365083472000},"page":"1790-1796","source":"Crossref","is-referenced-by-count":24,"title":["Instability of Tuberculin and Candida Skin Test Reactivity in HIV-infected Ugandans"],"prefix":"10.1093","volume":"158","author":[{"given":"JOHN L.","family":"JOHNSON","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SAM","family":"NYOLE","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ALPHONSE","family":"OKWERA","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CHRISTOPHER C.","family":"WHALEN","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PETER","family":"NSUBUGA","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"VUKOSAVA","family":"PEKOVIC","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ROBIN","family":"HUEBNER","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ROBERT S.","family":"WALLIS","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PETER N.","family":"MUGYENYI","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ROY D.","family":"MUGERWA","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JERROLD J.","family":"ELLNER","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, and Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio; National TB and Leprosy Control Programme, Joint Clinical Research Center, and Department of Medicine, Mulago Hospital and Makerere University, Kampala, Uganda; Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1998,12,1]]},"reference":[{"key":"2026032709054552700_B1","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/0962-8479(92)90033-G","article-title":"HIV-associated tuberculosis in developing countries: epidemiology and strategies for prevention.","volume":"73","author":"Narain","year":"1992","journal-title":"Tuber. Lung Dis."},{"key":"2026032709054552700_B2","first-page":"515","article-title":"HIV-associated tuberculosis in developing countries: clinical features, diagnosis, and treatment.","volume":"70","author":"Raviglione","year":"1992","journal-title":"Bull. World Health Organ."},{"key":"2026032709054552700_B3","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/0140-6736(93)91817-6","article-title":"Effect of isoniazid prophylaxis on incidence of active tuberculosis and progression of HIV infection.","volume":"342","author":"Pape","year":"1993","journal-title":"Lancet"},{"key":"2026032709054552700_B4"},{"key":"2026032709054552700_B5","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1056\/NEJM199709183371201","article-title":"A trial of three regimens to prevent tuberculosis in Ugandan adults infected with the human immunodeficiency virus.","volume":"337","author":"Whalen","year":"1997","journal-title":"N. Engl. J. 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