Rhinosinusitis and atopy in patients infected with HIV

Hypothesis: Rhinosinusitis is common during HIV infection; its prevalence i s uncertain and could probably be related to clinical features, immunoaller gological status, and diagnostic criteria. Methods: Seventy-four patients h ospitalized with HIV infection were prospectively evaluated for the presenc e of rhinosinusitis based on clinical findings, nasal endoscopy, or paranas al sinus computed tomography (CT), Immune status, nasal smear, features of atopy (based on the prick test), and its contribution to sinusal inflammato ry pathology were also evaluated. Results: Most patients were severely immu nosuppressed: CD4+ 155 +/- 201 cells/mL and 12 +/- 11% (mean +/- SD), Thirt y-five percent of the patients presented at least two criteria of rhinosinu sitis (clinical findings, nasal endoscopy, and CT: 35%; clinical findings a nd CT: 50%; nasal endoscopy and CT: 15%). CT scan showed multiple sinus inv olvement, opacification over 25% of the total volume of the maxillary sinus in 50% of patients, and opacification of the sphenoidal sinus in 40% of ca ses. Atopy was present in 18% of patients, a figure which reflects the expe cted prevalence in our geographic area. Two independent predictors were ass ociated with a higher probability of rhinosinusitis: bilateral absence of m axillary infundibular patency (odds ratio, 7.5; 95% CI = 2.03-27.9) and low total count (odds ratio, 0.99; 95% CI = 0.99-1.00) or percentage of CD4+ ( odds ratio, 0.93; 95% CI = 0.88-1.00). Conclusions: There is a high prevale nce of rhinosinusitis in HIV-infected individuals. This finding is related to a decreased cellular immunity, but it does not appear to be related to I gE-related immediate hypersensitivity. Nasal endoscopy should be the first- step diagnostic test. However, when clinical suspicion exists and endoscopy fails to explain symptoms, CT scan is a valuable adjunct to establish this diagnosis.