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Following the introduction, and now widespread availability, of combined antiretroviral therapy, HIV has become a chronic disease with minimal or indeed no negative impact on life expectancy. As a result, there is a growing public health interest in establishing the potential health effects of chronic HIV infection and long-term antiretroviral therapy. This case-control study from the Johns Hopkins Voice Center (JHVC) compared the diagnoses of 69 HIV-infected and 4178 controls not recorded to be infected with HIV treated at the JHVC over a two-year period (January 2016 to December 2017). The main findings were that HIV-positive patients were more likely to present with laryngeal cancer (15.9% vs. 3.4%, OR 5.43, p < 0.001) as well as chronic laryngitis (17.4% vs. 4.2%, OR 4.79, p < 0.001). Fungal and ulcerative laryngitis were also more likely to be identified in HIV-positive individuals (OR 9.45 and 6.29 respectively, p < 0.001 for both associations). Interestingly, laryngeal papillomatosis had a similar prevalence in both groups. It was noted that 79.4% of HIV-positive patients were either current or former smokers compared to 37.4% of controls, but the association of HIV-positivity with a laryngeal cancer diagnosis was reported to hold true even when adjusted for this confounding factor. This paper is a useful reminder that HIV-positive patients appear to be at higher risk of developing head and neck cancers, including laryngeal cancers, in addition to chronic inflammatory or infective pathologies. Close follow-up and a low threshold for biopsy in HIV-positive patients with a clinical diagnosis of infective or inflammatory laryngeal pathology is therefore advisable.

Laryngeal disorders in people living with HIV.
Piersiala K, Weinreb SF, Akst LM, et al.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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