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.