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Temporal trends in otolaryngologic findings among HIV-1-infected children in a population-based cohort
Amy S Sturt1, Andrew T Anglemyer, Kara DuBray
1From the *†Department of Medicine, Division of AIDS Medicine, Santa Clara Valley Medical Center, San Jose; and †Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA.
Insights
Pediatric otolaryngologic conditions are common in children with HIV-1. Early antiretroviral therapy (ART) significantly reduced the prevalence of these conditions, supporting current guidelines for HIV management.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Public Health
Background:
- Otolaryngologic conditions are frequently observed in children infected with human immunodeficiency virus type 1 (HIV-1).
- This study investigates the prevalence of pediatric HIV-1 otolaryngologic manifestations during the era of effective antiretroviral therapy (ART).
Purpose of the Study:
- To determine the prevalence of otolaryngologic conditions in children with HIV-1.
- To analyze trends in these conditions in relation to the introduction of antiretroviral therapy (ART).
Main Methods:
- A population-based, prospective, multicenter surveillance study was conducted.
- 276 children with perinatally acquired HIV-1 were monitored from 1988 to 2009.
- Otolaryngologic conditions were evaluated based on Centers for Disease Control (CDC) criteria (mild, moderate, severe).
Main Results:
- The most common diagnoses were otitis media (21%) and oropharyngeal thrush (17.4%).
- A significant temporal decline in mild and moderate otolaryngologic conditions was observed between the pre-ART and ART cohorts (P < 0.001).
- Most conditions occurred within the first two years of life.
Conclusions:
- Many HIV-1-related otolaryngologic conditions manifest in early childhood (first 2 years).
- A significant decrease in the prevalence of these conditions was noted with the advent of ART.
- Findings support early ART initiation to reduce morbidity and prevent disease progression in HIV-1-positive infants and children.
Background:
Otolaryngologic conditions are common among HIV-1-infected children. In this study, we provide data regarding prevalence of pediatric HIV-1 otolaryngologic manifestations in the era of antiretroviral therapy (ART).
Methods:
We conducted population-based, prospective, multicenter pediatric HIV-1 surveillance among 276 children with perinatally acquired HIV-1 from 1988 to 2009. All Center for Disease Control (CDC) mild, moderate and severe otolaryngologic conditions were evaluated.
Results:
CDC-defined, HIV-1-related otolaryngologic conditions among the 276 children were: 103, mild; 50, moderate and 20, severe. The majority [23.3% (24/103), 40.0% (20/50) and 50% (10/20)] of mild, moderate and severe diagnoses, respectively, occurred in the first year of life, with 53.4% (55/103), 66.0% (33/50) and 70% (14/20), respectively, occurring in the first 2 years of life. The most frequent diagnoses were otitis media [21% (58/276)] and oropharyngeal thrush [17.4% (48/276)]. There was a temporal decline by cohort in prevalence of mild and moderate otolaryngologic diagnoses which was significant for mild conditions: 90, pre-ART cohort and 13, ART cohort (P < 0.001) and moderate conditions: 47, pre-ART and 3, ART (P < 0.001).
Conclusions:
In our study, many CDC-defined, HIV-related otolaryngologic conditions occur in the first 2 years of life. Over 22 years of longitudinal follow up, there was a significant decline in prevalence of CDC-defined otolaryngologic conditions by temporal cohorts when comparing pre-ART and ART eras. This finding supports early ART administration to decrease morbidity in HIV-1-positive infants and children as well as current US and World Health Organization guidelines to prevent early HIV disease progression.
