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(Chest. 2003;124:412-413.)
© 2003 American College of Chest Physicians

Restoration of Antigen-Specific CD4 T-Cell Response Against Mycobacterium tuberculosis in HIV-Infected People

Meritxell Nomdedeu, MD1; Alex Soriano, MD1 and Montserrat Plana, MD, PhD1

Institut Clínic de Infeccions i Immunitat, Barcelona, Spain

Correspondence to: Àlex Soriano, MD, Servei de Malalties Infeccioses, Hospital Clínic Universitari, C/Villarroel 70, 08036 Barcelona, Spain; e-mail ASORIANO{at}clinic.ub.es

To the Editor:

In a recent issue of CHEST, Schluger et al1 (August 2002) reported on a very interesting study of the immune response against tuberculosis in HIV-infected patients who were receiving antiretroviral therapy. This finding is crucial in order to predict the relapse of tuberculosis infection and to develop new therapeutic approaches for HIV-infected people.2 However, there are some points in the study on which we would like to comment. (1) The proliferative response and amount of interferon-{gamma} secretion when peripheral-blood mononuclear cells were stimulated with H37Ra were not different, based on previous tuberculin skin test results. In this respect, it is possible that live and heat-killed Mycobacterium tuberculosis H37Ra might not be specific. Thus, the results concerning immune reconstitution after antiretroviral therapy cannot be attributed to the restoration of the immune response against M tuberculosis. In order to clarify this question, it would also be interesting to know the results obtained when peripheral-blood mononuclear cells were stimulated with the other tested antigens (Mycobacterium bovis bacillus Calmette-Guerin-expressing strain and purified protein derivative). (2) The authors considered that all HIV-positive subjects were latently infected by M tuberculosis, because they were born outside the United States or they had risk factors for tuberculosis infection. However, the authors were not able to affirm the definitive diagnosis of latent M tuberculosis infection.

Taking into consideration all these facts, we believe that the conclusions of Schluger et al1 should be considered cautiously since there is no evidence that the antigen used was a specific one. In the future, it would probably be useful to perform a new study using more specific antigens3 and to include patients with documented active and latent M tuberculosis infection.

References

  1. Schluger, N, Perez, D, Liu, Y (2002) Recontitution of immune responses to tuberculosis in patients with HIV infection who receive antiretroviral therapy. Chest 122,597-602[Abstract/Free Full Text]
  2. Shafer, R, Edin, B Tuberculosis in patients with human immunodeficiency virus: perspective on the past decade. Clin Infect Dis 1996;22,683-704[ISI][Medline]
  3. Berthet, F, Rasmussen, P, Rosenkrands, I, et al A Mycobacterium tuberculosis operon encoding ESAT-6 and a novel low-molecular-mass culture filtrate protein (CFP-10). Microbiology 1998;144,3195-3203[Abstract]

Neil W. Schluger, MD, FCCPR1-1

Columbia University, New York, NY

Correspondence to: Neil W. Schluger, MD, FCCP, Clinical Chief, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University, College of Physicians & Surgeons, 630 West 168th St, New York, NY 10032; e-mail: ns311{at}columbia.edu

To the Editor:

We agree with Dr. Soriano that the T-cell responses we described in our article may not be specific for Mycobacterium tuberculosis. However, we made no claim in the article that in fact they were specific. The article points out that there is a certain time course that describes the reconstitution of immune recognition of tuberculosis, and it is certainly reasonable to think, as Dr. Soriano suggests, that this description might apply to immune recognition of other pathogens as well.





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