Sturt Amy S, Anglemyer Andrew T, DuBray Kara, Maldonado Yvonne A
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.
Pediatr Infect Dis J. 2014 Mar;33(3):e76-80. doi: 10.1097/INF.0000000000000034.
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).
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.
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).
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.
耳鼻喉疾病在感染HIV-1的儿童中很常见。在本研究中，我们提供了抗逆转录病毒疗法（ART）时代儿科HIV-1耳鼻喉表现患病率的数据。
我们对1988年至2009年期间276例围生期感染HIV-1的儿童进行了基于人群的前瞻性多中心儿科HIV-1监测。对所有疾病控制中心（CDC）定义的轻度、中度和重度耳鼻喉疾病进行了评估。
276名儿童中，CDC定义的与HIV-1相关的耳鼻喉疾病有：轻度103例、中度50例、重度20例。轻度、中度和重度诊断分别有多数[23.3%（24/103）、40.0%（20/50）和50%（10/20）]发生在生命的第一年，分别有53.4%（55/103）、66.0%（33/50）和70%（14/20）发生在生命的前两年。最常见的诊断是中耳炎[21%（58/276）]和口腔念珠菌病[17.4%（48/276）]。轻度和中度耳鼻喉诊断的患病率随队列时间呈下降趋势，轻度疾病有显著下降：ART前队列90例，ART队列13例（P < 0.001）；中度疾病：ART前47例，ART后3例（P < 0.001）。
在我们的研究中，许多CDC定义的与HIV相关的耳鼻喉疾病发生在生命的前两年。经过22年的纵向随访，与ART前和ART时代相比，按时间队列划分的CDC定义的耳鼻喉疾病患病率显著下降。这一发现支持早期给予ART以降低HIV-1阳性婴幼儿的发病率，以及目前美国和世界卫生组织关于预防早期HIV疾病进展的指南。
