Question
Can I use a Mantoux test for TB with a high CD4 count?
4 February 2023. Related: All topics, Opportunistic infections, Other tests, TB.
Is it safe for me to get a Mantoux test for TB? I m on medication and undetectable. My CD4 count is above 1000.
Answer
Hi
Although Mantoux tests were used for many years, they are no longer recommended, especially in people living with HIV.
This is because the test depends on an immune response. The concern for HIV positive people is that if the CD4 count is very low, the immune system might not be strong enough to show a positive result.
Even though the results should be okay with a high CD4 count more recent tests are not much better.
Depending on where you live other TB tests have been developed that work better at low CD4 counts including GeneXpert, which was included in this Q&A:
https://i-base.info/qa/6166
Further info
TB and HIV coinfection (from the i-Base training manual)
https://i-base.info/ttfa/5-ois-and-coinfections/7-tuberculosis-tb
UK (BHIVA) guidelines on HIV and TB coinfection.
https://www.bhiva.org/TB-guidelines
This question from July 2016 was updated in February 2023 to stress that Mantoux testing is no longer recommended for people living with HIV.
Comment