Ear, nose and throat-head and neck manifestations and effect of antiretroviral therapy in human immunodeficiency virus infection in children : A case control study
Abstract
Background: HIV/AIDS has had a huge negative impact on the morbidity and mortality of
the Kenyan paediatric population. A high number of these children may present to the
otorhinolaryngologist even before the diagnosis of HIV has been made.
Objectives: The main aim of this study was to determine the ENT-HN manifestations and
effect of antiretroviral therapy (ART) in HIV -infected children seen in Kenyatta National Hospital
(KNI-l). The study also sought to correlate ENT -HN manifestations in HIV -infected children with
the immunological stage of HI V disease.
Design: Case control study.
Setting: Kenyatta National Hospital.
Methods: There were three study groups each with 115 HIV -infected children. The first
group comprised of ART-naive children. The second group was made up of children on ART for
not more than 6 months while the third group comprised of those children who had been on ART
for more than 6 months. Diagnosis of the various manifestations was made clinically and through
FNAC where necessary. Each patient had HIV clinical and immunological staging using the WHO
recommendations. Correlation between the ENT-HN manifestations and use of ART was made. In
the ART-naive patients, correlation was made between these manifestations and the HIV
immunological stage.
Results: At least one ENT-HN manifestation was observed in 56.5% of ART-naive
children, 42.6% of children on ART for not more than 6 months and 38.3% of those who had been
on ART for more than 6 months. The commonest manifestations in ART-naive children were oral
candidiasis (13.9%), cervical lymphadenopathy (10.4%), papulo pruritic dermatitis (10.4%), acute
recurrent rhinosinusitis (9.6%) and chronic bilateral parotitis (8.7%). Use of ART beyond 6 months
was found to significantly reduce the prevalence of ~ral candidiasis, chronic bilateral parotitis,
cervical lymphadenopathy and papulo pruritic dermatitis. Initiation of ART was associated with a
significant increase in the prevalence of CSOM within the first 6 months of therapy. In the ARTnaive
children, the study showed that oral candidiasis was significantly associated with severe
immunosuppression.
Conclusions: Children with HIV infection commonly present with unusual ENT-HN
diseases such as oral candidiasis, cervical lymphadenopathy, chronic bilateral parotitis and papule
pruritic dermatitis. Use of ART is significantly associated with a reduction of these manifestations.
CSOM may be a component of immune reconstitution inflammatory syndrome.
Publisher
University of Nairobi, School of Medicine