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HIV and mucosal disease pain and sinusitis
May 14, 2006

Hi,

I contracted HIV in March 2003. CD4 counts OK at 529 and 31%. But I have suffered TERRIBLY with oropharngeal pain and bi-temporal headaches (which are exacerbated by bending forward). I also go into an occasional general malaise. I know this question is slightly outside the topic of this forum, but I would be grateful for your advice.

A MRI scan shows EXTENSIVE mucosal disease of the ethmoid, sphenoid and maxillary sinuses as well as aerated pterygoid processes. Small retropharytngeal lymph nodes were seen. Mucosal disease was also seen by an ENT expert who told me to drink less coffee. This has had not relieved my symptoms. A neurologist is of the view that my bi-temporal headaches are caused by chronic mucosal disease in the sphenoid sinus (i.e. a type of chronic sphenoid sinusitis). He thought that the lymnpadenopathy and sinus disease seen on the MRI scan are significant. My blood tests also indicate possible mucosal inflammation.

I understand that catastrophe of the mucosal surface is not unusual during the chronic phase and I would be grateful for any advice on how the terrible discomfort can be alleviated. Would a short course of high dose steroids help? Should a biopsy and histology be done of the posterior pharyngeal wall and the sinuses? Do others experience this terrible inflammation of the mucosal lining and if so what has helped?

Response from Dr. Wohl

Sinus disease is common during HIV. If you are not achieving adequate drainage from your sinuses then sinus surgey may be the answer. Surgery can create openings to allow mucus to drain and not accumulate.

Nasal steroids can be of tremendous benefit. There is an interaction between the HIV drug Norvir (also found in Kaletra) and nasal steroids leading to higher levels of the steroid in the system. Oral steroids are reserved for severe cases of sinus disease and failure of nasal steroids.

Find out if you are a candiate for surgery. Do you need a course of antibiotics to reduce a sinus infection? Ask if nasal steroids have a chance of working and whether early on your should push the dose a bit higher than ususal.

DW



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