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HIV infection in infants and its effects on ENT physicians

Alimohamad Asghari

The HIV infection epidemic is still horrifyingly widespread. There were 4.5 million fatalities from HIV in 2001, with an estimated 1.4 million children afflicted. In the UK, paediatric cases are concentrated in places with high populations of infected adult immigrants and, to a lesser extent, in regions with high IV drug misuse rates. The southeast and London continue to have the highest incidence. Any clinician in any field might anticipate working with children who are HIV positive or have clinical AIDS as a result of the countrywide redistribution of immigrant and refugee families. The majority of children are vertically infected, meaning they are infected before, during, or after birth by their infected mother. Rates of transmission range from 15% to 20% in developed countries.

ENT doctors may treat children with HIV infection as their initial presentation, and they should have the proper suspicion levels for the diagnosis. The most frequent presenting symptoms are fever, hepatosplenomegaly, chronic or recurring diarrhoea, persistent generalised lymphadenopathy, and poor development. By the age of 12 months, 15–20% of untreated infants will have an AIDS-defining disease, often Pneumocystis pneumonia around 3–4 months of age. Without treatment, 70% of perinatally infected infants will show some indications or symptoms by the time they are 12 months old; the median age at which AIDS progresses is 6 years; and, by this time, 25–30% will have passed away. The average death age is nine years.

As well as frequent or unusual ear infections, tonsillitis, orbital/peri-orbital cellulitis, oral candidiasis, and dental infections, children can also present with sinus disease (including mastoiditis), ear infections, and sinusitis. Strep. Pneumonia and group streptococcus infections are frequent, and they frequently develop into severe systemic infections with a significant mortality. Unusual pathogens including Pseudomonas, "typical" and atypical Mycobacteria, Candida, Aspergillus, etc. can cause infections. Aspergillus and Rhizopus spp. infections of the sinuses can be particularly harmful because they spread quickly to affect bone and the central nervous system. Bilateral parotid enlargement is another traditional symptom that ENT practitioners may see, particularly in children who are "slow progresses" and who frequently develop lymphoid interstitial pneumonitis (LIP).

Advances in three key areas have led to a significant shift in attitudes: I the multidisciplinary management of the infected mother (including counselling, antenatal screening, elective caesarean section, advising against breastfeeding, etc.); (ii) the prevention of vertical transmission, using anti-retroviral therapy to the infected mother during pregnancy and to the potentially infected infant in the first few weeks of life; and (iii) significant advancements because of the development of new technologies Transmission rates could be lowered to 2% with the help of these strategies. However, none of the approaches affect a cure, and it will still be many years before efficient vaccines are developed.

Children who have previously been diagnosed with HIV may be referred to ENT specialists. There are several potential risks when talking to diseased kids (and their parents), so doing so requires cautious planning. The AIDS epidemic has necessitated a significant amount of reconsideration in many infection-control approaches. This has particularly been the case with regard to surgical safety, post-exposure prophylaxis, equipment sanitation and reuse, and needle stick injuries.