Abstract
BackgroundSwallowing disorders, well recognised in adults, contribute to HIV-infection morbidity. Little data however is available for HIV-infected children. The purpose of this study is to describe swallowing disorders in a group of HIV-infected children in Africa after the introduction of combined anti-retroviral therapy.MethodsWe describe 25 HIV-infected children referred for possible swallowing disorders. Clinical and videofluoroscopic assessment of swallowing (VFSS), HIV stage, and respiratory and neurological examination were recorded.ResultsMedian age was 8 months (range 2.8-92) and 15 (60%) were male. Fifteen (60%) were referred for recurrent respiratory complaints, 4 (16%) for poor growth, 4 (16%) for poor feeding and 2 (8%) patients for respiratory complaints and either poor growth or feeding. Twenty patients (80%) had clinical evidence of swallowing abnormalities: 11 (44%) in the oral phase, 4 (16%) in the pharyngeal phase, and 5 (25%) in both the oral and pharyngeal phases. Thirteen patients had a videofluoroscopic assessment of which 6 (46%) where abnormal. Abnormalities were detected in the oral phase in 2, in the pharyngeal phase in 3, and in the oral and pharyngeal phase in 1; all of these patients also had evidence of respiratory involvement. Abnormal swallowing occurred in 85% of children with central nervous system disease. CNS disease was due to HIV encephalopathy (8) and miscellaneous central nervous system diseases (5). Three of 4 (75%) patients with thrush had an abnormal oral phase on assessment. No abnormalities of the oesophagus were found.ConclusionsThis report highlights the importance of swallowing disorders in HIV infected children. Most patients have functional rather than structural or mucosal abnormalities. VFSS makes an important contribution to the diagnosis and management of these patients.
Highlights
Swallowing disorders, well recognised in adults, contribute to HIV-infection morbidity
We describe our experience with HIV-infected children referred for assessment of swallowing at Tygerberg Children’s Hospital in Cape Town, South Africa, a referral unit in a high HIV prevalence area
Twenty patients (80%) had clinical evidence of swallowing abnormalities: 11 (44%) in the oral phase, 4 (16%) in the pharyngeal phase and 5 (25%) in both the oral and pharyngeal phases (Table 1)
Summary
Swallowing disorders, well recognised in adults, contribute to HIV-infection morbidity. The purpose of this study is to describe swallowing disorders in a group of HIV-infected children in Africa after the introduction of combined anti-retroviral therapy. Swallowing disorders, often unrecognized in AIDS and other chronic diseases, significantly reduce quality of life [1] and increase morbidity and mortality: nutrition is adversely affected [2], the ability to take medication is reduced [3] and serious complications such as aspiration pneumonia [4] may occur. A wide range of swallowing difficulties occurs in HIV infected adults. Almost 80% of adults in an HIV clinic in South Africa [1] reported symptoms of swallowing disorders that adversely affected quality of life. Patients with lower CD4 counts had more severe symptoms, even patients who were not severely immune compromised often had swallowing abnormalities
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