[Chronic sinusitis in patients infected by HIV: therapeutic strategies]

Chronic sinus pathology is a frequently encountered disease in HIV infected patients. The responsible bacterial agents and management are yet to be settled. The authors report the results of a retrospective study led in the unit of Head and Neck Surgery of the University Hospital of Nice. 25 patients where HIV holders and had a sinus pathology which had lasted more than 6 weeks, despite one or several antimicrobial drug administrations. Clinical and CT scan data are detailed as well as pathology results of the samples harvested during sinus surgery (bacteria free 32%, Pseudomonas aeruginosa 32%, Streptococcus pneumoniae 16%, Staphylococcus aureus 16%, Hemophilus influenzae 16%, anaerobic agents 16% and Toxoplasma gondii 4%). All patients underwent surgery (antral puncture with maxillary sinus drainage 17, functional endoscopic sinus surgery 8). Results where gathered at 4 months with 76% of relapse (100% in patients with less than 200/mm3 CD4 cells). In conclusion empiric antimicrobial drug therapy will be expected to be also effective on Pseudomonas aeruginosa, the surgical management being most often deceiving and leading to relapse especially when considering the frequency of bilateral morbidity and the level of CD4 cell below 200/mm3.