OBJECTIVE: To compare the two-year survival of healthy Ugandans with skin test anergy and non-anergy to tuberculin and candida at baseline. DESIGN: Prospective cohort study. METHODS: Between 1993 and 1995, 321 (mean age 30.6 +/- 6.5 yrs., 31% male) anergic and 461 (30.4 +/- 6.6 yrs., 33% male) non-anergic to tuberculin and candida skin tests were recruited from an anonymous voluntary counseling testing centre in Kampala, Uganda. These subjects were enrolled in the non-intervention arm of a three-year clinical trial to assess the efficacy of TB chemoprophylaxis. They received regular medical care for concomitant illnesses throughout the study period. RESULTS: At baseline 15.9% of the non-anergic compared with 23.9% of the anergic had a prior history of herpes zoster (p < .001); and 35.5% of the non-anergic compared with 45.5% of the anergic had present or past genital ulcers (p < .001). The mean CD4 cell count in the non-allergic was 529 +/- 380 cells/mu. and 359 +/- 313 cells/microliter in the anergic (p < .001). Both groups had similar haemoglobin, total white cell counts, weights and body mass indices. After two years of follow-up, there had been 68 deaths in the non-anergic compared with 96 in the anergic for a product limit estimate log rank chi 2 of 23.0 (p < .001). In a proportional hazards model controlling for baseline CD4 cell count, the relative hazard for anergic was 1.14 p < .093, -2 Log-likelihood 8565, p < .001, from a univariate relative hazard of 1.24 (p < .004), -2 Log-likelihood of 8717. CONCLUSIONS: In HIV-infected persons, TB was independently associated with an increased risk for death, especially when the CD4+ count was greater than 200 cells/microL. In populations with high prevalence of co-infection, preventive therapy for TB in HIV-infected persons may have beneficial effect on individual survival.

MEETING ABSTRACTS Adult Clonal Anergy Cohort Studies Community Health Centers CD4 Lymphocyte Count Female Human HIV Infections/COMPLICATIONS/*IMMUNOLOGY/*MORTALITY Male Proportional Hazards Models Prospective Studies Skin Tests/STATISTICS & NUMER DATA Survival Rate Tuberculosis/COMPLICATIONS Uganda

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