Concurrent Otorhinolaryngologic and Ophthalmologic Abnormalities in Adults Living with HIV: A Cross-Sectional Study from a Tertiary Hospital in South-East Nigeria

Abstract

Background: Human immunodeficiency virus (HIV) infection is a multisystem disorder that may affect the ear, nose and throat (ENT) region and the ocular system. Although ENT and ophthalmologic manifestations have been extensively studied separately, there is limited information on the burden of concurrent disease involving both systems among people living with HIV, particularly in South East Nigeria. Objective: To determine the prevalence, pattern and predictors of dual ENT and ophthalmologic diseases among HIV-positive adults attending the ART clinic at Enugu State University of science and technology Teaching Hospital (ESUTH) Parklane, Enugu State, South East Nigeria. Method: This was a hospital-based cross-sectional study involving 139 consenting HIV-positive adults attending the ESUTH Parklane ART clinic between January and December 2024. Participants were assessed for ENT and ophthalmologic symptoms and abnormalities. ENT assessment included otoscopy, nasal examination/endoscopy, oral examination and hearing assessment, while ophthalmologic assessment included anterior-segment, posterior-segment and tear-film evaluation. Data were analysed using IBM SPSS Statistics version 27. Associations were assessed using the chi-square test, independent-samples t-test and Mann–Whitney U test as appropriate. Binary logistic regression was performed to identify independent predictors of dual disease. Statistical significance was set at p < 0.05. Results: The mean age of the participants was 45.16 ± 12.27 years, and 96 (69.1%) were female. Fifty participants (36.0%) had concurrent ENT and ophthalmologic disease. Common ENT symptoms included ear pain (21.6%), ear discharge (15.1%) and sore throat (13.7%), while common ophthalmic symptoms were blurred vision (38.1%), excessive tearing (36.7%) and eye pain (23.0%). Objective examinations identified hearing impairment in 38 (27.3%), abnormal otoscopy in 36 (25.9%) and oral lesions in 29 (20.9%). Ocular examination identified tear-film abnormalities in 62 (44.6%) and posterior-segment abnormalities in 47 (33.8%). No significant association was found between dual disease and age, sex, duration of HIV infection, ART status, CD4 count, viral load or WHO clinical stage. Logistic regression identified no independent predictor of dual disease. Conclusion: Concurrent ENT and ophthalmologic abnormalities were present in more than one-third of HIV-positive adults in this study. The higher frequency of several objective abnormalities than reported symptoms indicates that clinically important disease may be under-recognised when assessment relies on symptoms alone. Integrated ENT and ophthalmologic awareness should therefore be considered within comprehensive HIV care.