Sinus Infection called sinusitis is a common problem affecting many people with HIV. It can happen at any time, yet is more severe and difficult to treat in individuals with CD4 counts of less than 200.
What Are Sinuses?
Sinuses, located just above the eyebrows, on each side of the nose, just above the upper jaw, and toward the base of the skull, are hollow spaces in the bones of the skull which contain air and connect with the nostrils. They produce mucus, which drains into the nasal cavity. Their function is believed to help warm and moisten inhaled air.
Sinusitis often causes pain and tenderness over the lower forehead, and/or the cheeks, and sometimes pain in the teeth. It may cause pain behind the eyes accompanied by redness and pain on the sides of the nose. Tearing of the eyes, and sensitivity to light has also been associated with sinusitis.
The most common symptoms of sinusitis include fever, nasal congestion or discharge, and pain. In some cases fever and/or headache are the only symptoms.
Sinusitis occurs when the mucosal lining of the sinuses becomes inflamed and/or infected. It is not completely understood why people with HIV suffer from sinusitis so frequently.
People with HIV are at increased risk for any type of bacterial infection. Bacterial infections of the oral cavity are common and represent a source of potential continuous infection. It is often difficult to pinpoint the type of bacteria that is causing the infection.
For acute sinusitis, the first step often includes the use of Aspirin or Ibuprofan and the application of heat for comfort. Decongestants such as Sudafed can be particularly helpful. These can be taken either orally or by nasal spray. Spray each nostril once, then wait a minute to allow the anterior nasal mucosa to shrink. Then spray again to reach the upper mucosa. This procedure can be repeated every four hours for several days if needed.
Antihistamines are not usually helpful because they cause the fluids to thicken which prevent drainage. Many doctors are now prescribing "Suldane" or "Entex" for relief of sinusitis.
Augmentin at 500mg three times a day, for three weeks, is an antibiotic regimen that is often prescribed. If sinusitis does not respond to the antibacterial regimen, it may be that the condition is being caused by fungi. Fungal infections can be treated with drugs such as fluconazole.
If these therapies fail, some individuals resort to surgery. The procedure physically widens the sinus passages to allow for better drainage and is often effective.
Seattle Treatment Education Project