OTOLARYNGOLOGIC DISEASE PROGRESSION IN CHILDREN WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Objectives: To evaluate the prevalence of otolaryngologic disease in c hildren born to mothers infected with human immunodeficiency virus (HI V) and to assess the correlation between HIV disease severity and the incidence density of recurrent otitis media (OM) and sinusitis based o n the revised 1994 Centers for Disease Control and Prevention (CDC) cl inical-severity index. Design: Case series. Setting: Academic, tertiar y 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 w ere found not to be infected (''seroreverters''), followed up on a reg ular basis since birth. Main Outcome Measures: Prevalence of recurrent OM (3 episodes in 6 months or 4 episodes in 12 months), sinusitis, pa rotitis, and lymphadenopathy, incidence density of recurrent OM and si nusitis based on the 1994 CDC clinical-severity index. Results: Sixty- four HIV-infected children (44%) and 13 seroreverters (8.5%) had recur rent OM (P <.001); 29 HIV-infected children (20%) and 1 seroreverter ( 0.6%) had sinusitis (P <.001). Eight HIV-infected patients developed t ympanic membrane perforations and 25 HIV-infected children required ot ologic surgery. Three HIV-infected children required otologic surgery. Three HIV-infected patients had parotitis. The incidence density of r ecurrent 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. Concl usion: The prevalence of recurrent OM and sinusitis is significantly g reater in HIV-infected children than in seroreverters. The incidence d ensity of recurrent OM also significantly correlates with disease prog ression in HIV-infected children as measured by the 1994 CDC clinical- severity index.