Introduction

Human Immunodeficiency Virus (HIV) is a retrovirus that targets and impairs helper T-cells, leading to compromised cell-mediated and humoral immunity [1]. Transmission primarily occurs through direct exposure to infected blood and specific bodily fluids, as well as via the use of unsterile medical or dental equipment, unprotected sexual intercourse, and the sharing of unsterile needles or personal hygiene items like razors and toothbrushes.

Despite being identified as a pathogen three decades ago, HIV remains a significant global pandemic, with escalating infection rates worldwide, posing a substantial public health burden [2].

Antiretroviral therapy (ART) is the mainstay of HIV management, aiming to suppress viral replication within the body [3]. Over the years, advancements in treatment modalities, coupled with enhanced education and awareness programs, have fostered greater patient adherence to therapy [4]. Consequently, there has been a notable expansion in the accessibility and utilization of antiretroviral medications, contributing significantly to the improved clinical outcomes and overall prognosis for individuals living with HIV [5].

Otorhinolaryngological diseases and HIV have a well-established link. Several studies have shown that 80% of HIV-infected patients present with ear, nose and throat symptoms. Candidiasis, rhinosinusitis, allergic rhinitis, lymph node enlargement in the neck, adenoid enlargement, and chronic otitis media are commonly reported in HIV infected patients [6].

Certain otorhinolaryngological conditions are recognized as opportunistic infections in the context of HIV and are key criteria in the World Health Organization's clinical staging of the disease [7]. Immunodeficiency due to HIV can be a possible risk factor for diseases such as COVID-19 [8].

The otorhinolaryngological manifestations in association with HIV infection are non-specific and fairly common in clinical practice, therefore, immunodeficiency may not be suspected [9]. The severity of otorhinolaryngological manifestations tends to escalate with advanced stages of HIV disease [10]. In this study, only patients receiving ART were included to see whether increased accessibility and availability of ART have influenced the clinical landscape of otorhinolaryngological manifestations associated with HIV infection.

Aim

Our study focuses on assessing the various otorhinolaryngological manifestations in HIV patients receiving treatment at our ART center and the impact of ART on the patterns of presentation.

Material and Methods

It was an observational, cross-sectional study carried out in the Department of Otorhinolaryngology, Grant Medical college and Sir JJ Group of Hospitals, Mumbai, India from December 2022 to February 2024. The Institutional Ethics Committee approved the study protocol (meeting date; 23/11/2022, decision number; IEC/PG/977/NOV/2022) with approval of National AIDS Control Organization (NACO) and Mumbai District AIDS Control Society (MDACS) (approval number – MDACS/805/APD). A written informed consent was obtained from all the patients after explaining the objectives of the study. Precautions were taken throughout the study to safeguard the rights and confidentiality of all the participants.

Inclusion Criteria

Patients of either sex, above 18 years of age who were HIV infected and were on antiretroviral therapy presenting with ear, nose, throat symptoms to the ART Centre were referred to Department of Otorhinolaryngology for further evaluation and were included in the study.

Exclusion Criteria

Patients not willing to give consent were excluded from this study.

Methodology

100 patients meeting the inclusion criteria were enrolled in the study after taking written informed consent. Thorough history taking and clinical examination of patients was done and the collected data was analysed. Continuous variables were presented by median (interquartile range). Categorical variables were tested between groups of patients using Chi-2 or Fisher’s exact test.

Results

In our study, we included 100 patients diagnosed with HIV, on antiretroviral  therapy. Among them 76 were male (76%) and 24 females (24%). These patients were further distributed based on age groups and it was observed that maximum patients were in the age group of 48-57yrs (31%). Out of the 100 patients, it was found that 32 patients (32%) had CD4 counts less than 200 cells/mm3, 28 patients (28%) had counts between range of 200-349 cells/mm3, 18 patients (18%) had counts between range of 350-499 cells/mm3 and 22 patients (22%) had counts of more than 500 cells/mm3. 25% of patients reported a positive family history of HIV infection, including 22% with an HIV-positive spouse and 3% with one or both parents being HIV-positive.

 

Figure 1: Distribution of patients according to age group.

 

Figure 2: Distribution of CD4 counts among patients 

The most common presentation was of oropharyngeal manifestations which were seen in 43 patients (43%), out of which oral candidiasis was the most common which was seen in 23 patients (44.23%), followed by herpes labialis which was seen in 9 patients (17.3 %), 6 patients (11.5%) presented with leukoplakia and 5 patients (9.6%) presented with tonsillitis.

Of the nose manifestations which were seen in total of 15 patients (15%), the most common was rhinosinusitis, seen in 7 patients (46.66%), followed by allergic rhinitis which was seen in 5 patients (33.33%), 2 patients (13.3%) presented with adenoid hypertrophy and 1 patient (6.67%) presented with septal abscess.

 

Figure 3: Oral candidiasis seen in a patient of our study.