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Endoscopic sinus surgery in patients infected with HIV
M Friedman1, R Landsberg, H Tanyeri
1Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-Saint Luke's Medical Center, Chicago, Illinois 60612-3833, USA.
The Laryngoscope
|October 19, 2000
Summary
Standard endoscopic sinus surgery (ESS) offers a high success rate for patients with HIV-associated sinusitis, comparable to those without HIV. Low CD4 counts do not contraindicate this effective treatment.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Surgical Oncology
Background:
- Sinusitis in patients with Human Immunodeficiency Virus (HIV) can be refractory to medical management.
- Surgical intervention is sometimes necessary for HIV-positive patients with persistent sinusitis.
Purpose of the Study:
- To evaluate the efficacy and safety of surgical treatments for sinusitis in patients with HIV.
- To establish guidelines for planning surgical interventions in this patient population.
Main Methods:
- Retrospective chart review of 106 HIV-positive patients who underwent surgery for sinusitis between 1987 and 1998.
- Data collected included symptoms, radiographic findings, CD4 counts, and surgical procedures.
- Comparison of outcomes between early (limited) and later (standard ESS) surgical approaches.
Main Results:
- Early surgical approaches (1987-1991) with limited procedures resulted in an 80.6% recurrence or complication rate.
- Since 1992, standard endoscopic sinus surgery (ESS) in 52 patients achieved symptom improvement in 75% of cases.
- This success rate with ESS is comparable to that observed in HIV-negative patients.
Conclusions:
- Standard ESS is a safe and effective treatment for sinusitis in HIV-positive patients.
- HIV-positive patients with surgical indications for sinusitis should be managed similarly to HIV-negative patients.
- Low CD4 counts (<100) are not a contraindication for definitive surgical treatment.