EN4.46 | HIV Manifestations in ENT — Summary & Reflection

KEY TAKEAWAYS

HIV affects the entire head and neck region, and ENT manifestations are among the most common and clinically important presentations of HIV disease. The spectrum of involvement correlates with CD4 count: oral candidiasis and oral hairy leukoplakia appear early; Kaposi's sarcoma and HIV-associated lymphoepithelial cysts at intermediate stages; and non-Hodgkin lymphoma and severe opportunistic infections at very low CD4 counts.

Key pattern recognition points: White plaques that wipe off = candida; corrugated white patches on lateral tongue that do NOT wipe off = oral hairy leukoplakia (EBV; pathognomonic of immunosuppression); violaceous lesions on hard palate = Kaposi's sarcoma (HHV-8); bilateral soft parotid swellings with intraparotid cysts = HIV lymphoepithelial cysts; rapidly enlarging neck mass = NHL until FNAC proves otherwise.

Investigation principles: CD4 count and viral load provide the immunological context; local investigations (KOH mount, biopsy, FNAC, audiometry) provide tissue-level diagnoses.

Management principles: ART is the cornerstone — immune reconstitution resolves many manifestations. Specific treatments: fluconazole for candidiasis; intralesional vinblastine/systemic chemotherapy for KS; R-CHOP for NHL. ENT role: biopsy for diagnosis, airway management for KS/lymphoma obstructing the larynx, FESS for refractory sinusitis.

REFLECT

Consider how you would approach a patient presenting to a general outpatient clinic with persistent oral ulcers and bilateral neck gland swelling. What cluster of additional findings would prompt you to offer HIV testing, and how would you navigate that conversation sensitively? Now consider the reverse scenario: a known HIV-positive patient presents with a rapidly enlarging neck mass. What are the diagnostic possibilities, in order of urgency, and which single investigation provides the most useful initial information? Reflect on the role of the ENT clinician in the multidisciplinary care of HIV-positive patients — not just as a surgeon, but as a diagnostician who may be the first doctor to recognise the HIV diagnosis through a head and neck pattern.