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The ENT manifestations of HIV infection in children
P J Hadfield1, M A Birchall, V Novelli
1Department of Paediatric Otolaryngology, Great Ormond Street Hospital for Children NHS, London, UK.
Insights
Most children with human immunodeficiency virus (HIV) infection experience ear, nose, and throat (ENT) symptoms, often common childhood illnesses or specific conditions like candidiasis. ENT surgeons should anticipate increased cases in pediatric patients, recognizing these symptoms as potential indicators of immunodeficiency.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Immunology
Background:
- Human immunodeficiency virus (HIV) infection in children presents unique clinical challenges.
- Understanding the spectrum of otolaryngologic (ENT) manifestations is crucial for early diagnosis and management.
- Previous studies have not fully characterized the ENT symptoms in a pediatric cohort over an extended period.
Purpose of the Study:
- To identify and characterize the incidence, nature, and age of onset of ENT symptoms in HIV-infected children.
- To compare the ENT clinical features of HIV-infected children with those of HIV-infected adults and non-infected children.
- To inform ENT surgeons about the potential increase in pediatric HIV cases and associated conditions.
Main Methods:
- Retrospective analysis of 66 HIV-infected children treated between 1986 and 1993.
- Detailed review of medical records to document ENT symptoms, diagnoses, and age at onset.
- Comparison of observed ENT conditions with known patterns in adult HIV patients and the general pediatric population.
Main Results:
- 91% of HIV-infected children presented with ENT symptoms.
- The most frequent symptoms included cervical lymphadenopathy, oropharyngeal candidiasis, and otitis media.
- Children exhibited both common childhood ENT diseases (with increased susceptibility) and HIV-specific conditions like diffuse parotid swelling, differentiating them from other groups.
Conclusions:
- HIV-infected children frequently experience a range of ENT symptoms, including common pediatric conditions and specific HIV-related manifestations.
- ENT findings in pediatric HIV can differ significantly from those in adults and non-infected children.
- ENT surgeons may encounter more HIV-infected children, and ENT conditions can be the initial sign of underlying immunodeficiency.
Abstract:
This study identified the ENT symptoms of 66 HIV infected children over an 8 year period (1986-1993) at Great Ormond Street Hospital for Children. The incidence, nature and age of onset of ENT symptoms were investigated; 91% of the children had ENT symptoms, the most common being cervical lymphadenopathy, oro-oesophageal candidiasis and otitis media. The HIV infected children suffered from the common ENT diseases of childhood. They also presented with specific conditions such as diffuse parotid swelling. Therefore, their clinical features differed from HIV infected adults as well as non-infected children. An increasing incidence of paediatric HIV infection was demonstrated by the study. Most were due to vertical transmission. ENT surgeons are likely to see more HIV infected children in future, either with the usual ENT diseases of childhood (to which they seem more susceptible) or with HIV-specific conditions. Although the diagnosis of HIV may be known, the ENT condition could be the initial presentation suggestive of immunodeficiency.