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Otolaryngologic disease progression in children with human immunodeficiency virus infection
A Y Chen1, L A Ohlms, M G Stewart
1Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Tex, USA.
Insights
Children with human immunodeficiency virus (HIV) infection experience higher rates of recurrent otitis media and sinusitis. Recurrent otitis media incidence density correlates with HIV disease progression, highlighting the need for monitoring otolaryngologic health in these children.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Immunology
Background:
- Children born to mothers with human immunodeficiency virus (HIV) infection face unique health challenges.
- Otolaryngologic (ear, nose, and throat) diseases are common in pediatric populations.
- Understanding the specific risks in vertically HIV-infected children is crucial for timely intervention.
Purpose of the Study:
- To determine the prevalence of otolaryngologic diseases in children with vertically acquired HIV infection.
- To assess the relationship between HIV disease severity and the incidence of recurrent otitis media (OM) and sinusitis.
- To compare these outcomes with a control group of children with maternal HIV exposure but no infection (seroreverters).
Main Methods:
- A case series study was conducted at a tertiary care children's hospital.
- One hundred forty-five vertically HIV-infected children and 153 seroreverter children were followed since birth.
- Prevalence of recurrent OM, sinusitis, parotitis, and lymphadenopathy was recorded, along with incidence density of recurrent OM and sinusitis based on the 1994 CDC clinical-severity index.
Main Results:
- HIV-infected children had significantly higher rates of recurrent OM (44% vs. 8.5%) and sinusitis (20% vs. 0.6%) compared to seroreverters.
- The incidence density of recurrent OM increased with worsening HIV clinical and immunologic status.
- Sinusitis incidence density did not show a significant correlation with HIV disease severity.
Conclusions:
- Vertically HIV-infected children exhibit a substantially greater prevalence of recurrent otitis media and sinusitis.
- The incidence of recurrent otitis media in HIV-infected children is linked to disease progression, as indicated by the 1994 CDC clinical-severity index.
- These findings underscore the importance of vigilant otolaryngologic surveillance in children with HIV infection.
Objectives:
To evaluate the prevalence of otolaryngologic disease in children born to mothers infected with human immunodeficiency virus (HIV) and to assess the correlation between HIV disease severity and the incidence density of recurrent otitis media (OM) and sinusitis based on the revised 1994 Centers for Disease Control and Prevention (CDC) clinical-severity index.
Design:
Case series.
Setting:
Academic, tertiary care children's hospital.
Patients:
One hundred forty-five children (73 boys, 72 girls) with vertically acquired HIV infection and 153 (77 boys, 76 girls) children who had maternal exposure to HIV but later were found not to be infected ("seroreverters"), followed up on a regular basis since birth.
Main Outcome Measures:
Prevalence of recurrent OM (3 episodes in 6 months or 4 episodes in 12 months), sinusitis, parotitis, and lymphadenopathy; incidence density of recurrent OM and sinusitis based on the 1994 CDC clinical-severity index.
Results:
Sixty-four HIV-infected children (44%) and 13 seroreverters (8.5%) had recurrent OM (P < .001); 29 HIV-infected children (20%) and 1 seroreverter (0.6%) had sinusitis (P < .001). Eight HIV-infected patients developed tympanic membrane perforations and 25 HIV-infected children required otologic surgery. Three HIV-infected patients had parotitis. The incidence density of recurrent OM increased as HIV clinical (P = .001) and immunologic (P = .03) status worsened. In contrast, the incidence density of sinusitis did not significantly correlate with increased HIV disease severity.
Conclusion:
The prevalence of recurrent OM and sinusitis is significantly greater in HIV-infected children than in seroreverters. The incidence density of recurrent OM also significantly correlates with disease progression in HIV-infected children as measured by the 1994 CDC clinical-severity index.