title: Temporal trends in otolaryngologic findings among HIV-1-infected children in a population-based cohort.
abstract: 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.
authors.affiliation: 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.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Sturt
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Anglemyer
authors.forename: Kara
authors.initials: K
authors.lastname: DuBray
authors.forename: Yvonne A
authors.initials: YA
authors.lastname: Maldonado
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D002180:Candidiasis, Oral / Q000150:complications* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010038:Otorhinolaryngologic Diseases / Q000150:complications* / Q000453:epidemiology*
chemical_list: D019380:Anti-HIV Agents