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Temporal Trends in Otolaryngologic Findings among HIV-1-infected Children in a Population-based Cohort

Sturt, Amy S. MD*†; Anglemyer, Andrew T. PhD; DuBray, Kara MD; Maldonado, Yvonne A. MD

The Pediatric Infectious Disease Journal: March 2014 - Volume 33 - Issue 3 - p e76–e80
doi: 10.1097/INF.0000000000000034
HIV Reports

Background: Otolaryngologic conditions are common among HIV-1-infected children. In this study, we provide data regarding prevalence of pediatric HIV-1 otolaryngologic manifestations in the era of antiretroviral therapy (ART).

Methods: We conducted population-based, prospective, multicenter pediatric HIV-1 surveillance among 276 children with perinatally acquired HIV-1 from 1988 to 2009. All Center for Disease Control (CDC) mild, moderate and severe otolaryngologic conditions were evaluated.

Results: CDC-defined, HIV-1-related otolaryngologic conditions among the 276 children were: 103, mild; 50, moderate and 20, severe. The majority [23.3% (24/103), 40.0% (20/50) and 50% (10/20)] of mild, moderate and severe diagnoses, respectively, occurred in the first year of life, with 53.4% (55/103), 66.0% (33/50) and 70% (14/20), respectively, occurring in the first 2 years of life. The most frequent diagnoses were otitis media [21% (58/276)] and oropharyngeal thrush [17.4% (48/276)]. There was a temporal decline by cohort in prevalence of mild and moderate otolaryngologic diagnoses which was significant for mild conditions: 90, pre-ART cohort and 13, ART cohort (P < 0.001) and moderate conditions: 47, pre-ART and 3, ART (P < 0.001).

Conclusions: In our study, many CDC-defined, HIV-related otolaryngologic conditions occur in the first 2 years of life. Over 22 years of longitudinal follow up, there was a significant decline in prevalence of CDC-defined otolaryngologic conditions by temporal cohorts when comparing pre-ART and ART eras. This finding supports early ART administration to decrease morbidity in HIV-1-positive infants and children as well as current US and World Health Organization guidelines to prevent early HIV disease progression.

From the *†Department of Medicine, Division of AIDS Medicine, Santa Clara Valley Medical Center, San Jose; and Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA.

Accepted for publication July 25, 2013.

A.S.S. was supported by National Institutes of Health training grant “Applied Genomics in Infectious Diseases,” T32 AI 07502-13 and T32 AI 070502-14.

The authors have no other funding or conflicts of interest to disclose.

Address for Correspondence: Amy S. Sturt, MD, Santa Clara Valley Medical Center, Ira Greene PACE Clinic, 2400 Moorpark Avenue, Suite 316, San Jose, CA 95128. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.