Changing patterns of HIV infection in otolaryngology

Nasal manifestations of systemic illnesses

This article is focused on the nasal and sinusal manifestations of systemic diseases, such as infections, immunodeficiencies, chronic multisystemic disorders, inflammatory bowel diseases, deposition diseases, hematologic diseases, respiratory diseases, and smell and taste disorders. A concise review of some of the systemic diseases that commonly present complaints in the nose and paranasal sinuses, including their prevalence, sinonasal manifestations, diagnosis, and treatment, is provided.

Otorhinolaryngological manifestations in children with human immunodeficiency virus infection

The otorhinolaryngological manifestations (ENTM) in AIDS were first described in 1983. Continuing research confirmed that the ENTM reached up to 100% of the infected individuals. In the infant population, this percentage is also found, differing by presenting specific ENTM. The main objectives of this study were to define the most common ENTM in HIV children and to observe the difference, when compared to non-infected children. The HIV detection was also correlated with the appearance of the first ENTM. The observational, case-control research involved the study of 40 children over a period of 1 year. It was found that HIV children have a higher occurrence of ENTM, herpes simplex virus gingivostomatitis, cervical lymphadenopathy and parotid hypertrophy. On the other hand, the proportion of children who developed rhinosinusitis, acute otitis media (AOM) and oral candidiasis (OC) were not statistically different among the groups. However, 90% of the HIV children presented at least one ENTM, as opposed to 45% of the immunocompetent children. Differences in the occurrence of the ENTM were noticed, some more suggestive of the HIV infection. Furthermore, the majority of the infected children had their first ENTM diagnosed before the infection of HIV was established.

Prevalence of sinonasal symptoms in patients with HIV infection

Infection with the human immunodeficiency virus (HIV) is increasing in prevalence, and disease patterns are changing as patient survival lengthens. The purpose of this cross-sectional epidemiological study was to assess the prevalence and severity of self-reported symptoms of otolaryngologic disease in a group of patients attending a general HIV outpatient clinic (n = 203), and to compare the prevalence of self-reported symptoms with a sample of patients without HIV infection (n = 100). Of the HIV-infected patients, 65% of patients had AIDS, 35% were HIV-positive, and the median CD4 count was 135. Although only 11% of patients had seen an otolaryngologist in the prior 6 months, the majority of patients (66%) reported the presence of sinonasal disease during that time. Allergic rhinitis (80%) and sinusitis (54%) were the most commonly reported sinonasal symptoms, and 44% regularly used nasal or sinus medications. Sinonasal disease severity was significantly higher than the self-reported severity of mouth/throat disease (p = 0.01), ear disease (p = 0.03), and neck/salivary disease (p = 0.01). Although patients' self-reported overall health status was associated (p = 0.02) with CD4 count, the severity of sinonasal symptoms was not associated (p = 0.93) with CD4 count. Similarly, sinonasal symptom severity did not differ between HIV-positive and AIDS patients (p = 0.45). In other words, sinonasal disease severity did not improve as general health status improved.

Nasal mucosal cell alterations in HIV-infected patients

Patients with HIV infection often have nasopharyngeal symptoms related to inflammatory or infectious diseases of the upper respiratory tract. In this study, we examined specific nasal mucosal cytologic alterations in adult patients with HIV infection for associations with nasopharyngeal symptoms and other clinical parameters. Mucosal cytology was obtained in 62 patients from an urban HIV clinic using a plastic curettelike probe. The quantities of goblet cells, vacuolated cells, and leukocytes were determined and analyzed for associations with various clinical aspects of these patients and specifically with the presence or absence of prolonged (> 2-week duration) nasopharyngeal symptoms. Goblet cell, but not vacuolated cell, increases were observed in samples in which nasal eosinophilia was present and in samples obtained from April to October without specific associations with nasopharyngeal symptoms or histories of atopic disease. A history of allergic rhinitis or recent upper respiratory infection was significantly associated with increased proportions and total numbers of epithelial cells that showed vacuolization. In patients with prolonged nasopharyngeal symptoms, significantly higher numbers of nasal leukocytes were observed but higher proportions of vacuolated cells were not. Scores of tests for abnormal physical findings in the nose were higher for patients with prolonged nasopharyngeal symptoms than for those without. Peripheral blood CD4 concentrations, gender, nasal substance abuse history, and other comorbidities did not influence either vacuolated cell or goblet cell quantities. These data show that prolonged nasopharyngeal symptoms in HIV infection are associated with a certain nasal cellular pattern. It is conceivable that this pattern relates to recurrent or prolonged nasal inflammation secondary to upper respiratory infection.

The ENT manifestations of HIV infection in children

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.