Prevalence of chronic ear disease among HIV+ children in Sub-Saharan Africa
David C Ianacone1, Alden F Smith1, Margaretha L Casselbrant2
1Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Insights
Chronic ear disease, including tympanic membrane perforations, is significantly more prevalent in children treated with highly active anti-retroviral therapy (HAART) for HIV. Otorrhea and cholesteatoma were exclusively observed in the HIV-positive group, highlighting increased ear health risks.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Public Health
Background:
- Chronic middle ear disease is suspected to be common in Ethiopian children, particularly those with HIV/AIDS.
- Limited research exists on chronic ear disease prevalence in HIV-positive children, especially those on HAART.
Purpose of the Study:
- To determine the prevalence of chronic ear disease in HIV-positive children receiving HAART.
- To compare this prevalence with that in age-matched, healthy, HIV-unexposed children in a similar environment.
Main Methods:
- Otolaryngologists conducted full head and neck examinations, including otoscopy and microscopic otoscopy.
- Medical records were reviewed to document tympanic membrane (TM) perforations, tympanosclerosis, TM atrophy, otorrhea, and cholesteatoma.
- 112 HIV-positive and 162 HIV-unexposed children were included in the study.
Main Results:
- TM perforations were significantly more common in HIV-positive children (17%) compared to HIV-unexposed children (3%).
- Otorrhea was present in 8% of HIV-positive children, while cholesteatoma was diagnosed in 2% of this group; neither was found in the HIV-unexposed group.
- Tympanosclerosis and TM atrophy were not more frequent in HIV-positive children.
Conclusions:
- TM perforations are significantly more prevalent in HAART-treated HIV-positive children than in healthy controls.
- Otorrhea and cholesteatoma were found exclusively in the HIV-positive cohort, indicating a higher risk of severe ear pathology.
Objectives:
To determine the prevalence of chronic ear disease in HIV+, highly active anti-retroviral therapy (HAART)-treated children and compare this to the prevalence in healthy children of similar age living in a similar setting.
Introduction:
From previous clinical work in Ethiopia, we suspected that chronic middle ear disease was common both in the general pediatric population and especially among children with HIV/AIDS. Few studies have examined the prevalence of chronic ear disease in HIV + children, particularly in those treated with HAART.
Methods:
Full examination of the head and neck was performed by otolaryngologists. This including cleaning of cerumen, otoscopy and microscopic otoscopy when needed. Patient's medical records were reviewed. Presence or absence of tympanic membrane (TM) perforation (unilateral or bilateral), tympanosclerosis, TM atrophy, otorrhea and/or cholesteatoma was documented.
Results:
112 HIV+ and 162 healthy (HIVU) children were included. Prevalence of TM perforations was 17% in the HIV + infected versus 3% in the HIVU (Fisher's-Exact-Test; OR: 7.2, 95% CI 2.5-20, p-value <0.0001). Presence of unilateral TM perforations was 12% in the HIV + population and 2% in the HIVU population (Fisher's-Exact-Test; OR: 6.8, 95% CI 2.0-22, p-value 0.002). The presence of bilateral perforations was 4% in the HIV + population and 1% in the HIVU population (Fisher's-Exact-Test; OR: 6.8, 95% CI 1.1-42, p-value 0.088). In the HIV + cohort, 2% were diagnosed with cholesteatoma compared to 0% in the HIVU population (95% CI HIV+ 0.002-0.06; HIVU 0.0-0.02) and 8% of HIV + subjects had active middle ear discharge, compared to 0% in the HIVU population (95% CI HIV+ 0.04-0.1; HIVU 0.0-0.02). Neither tympanosclerosis nor tympanic membrane atrophy was more frequent in the HIV + population compared to the HIVU population. Persistent or recurrent TM perforation was not more frequent in children with prior tympanoplasty in the HIV + population compared to the HIVU population.
Conclusion:
TM perforations are significantly more common in HAART-treated HIV + children than in healthy, age-matched HIVU population. Otorrhea and cholesteatoma were found only in the HIV + cohort.
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