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Aggressive Juvenile-Onset Respiratory Papillomatosis in a High HIV Prevalence Setting: Clinical Predictors of Severity in South Africa

Year: 2025

Type: article

Abstract: Background Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a chronic, HPV-driven condition marked by recurrent airway papillomas. This study aimed to determine the prevalence and incidence of JoRRP and to identify clinical predictors of aggressive JoRRP. Methods We conducted a retrospective analysis of JoRRP patients treated at Inkosi Albert Luthuli Central Hospital from 2012 to mid-2023. Demographics, patient HIV status, exposure to maternal HIV, frequency of surgical interventions, and extralaryngeal involvement were recorded. Results The cohort of 277 patients had a median diagnosis age of 4 years. The incidence of JoRRP was 3.82 per 100 000 live births (95% CI, 2.86–5.01), and prevalence was 4.17 per 100 000 population (95% CI, 3.47–4.97). Half of the study cohort met the criteria for aggressive disease (AD) (139; 50%). Children diagnosed at ≤2 years of age had higher odds of AD than older children, 3–5 years (OR: 0.43, 95% CI: 0.24–0.78) and >5 years (OR: 0.30, 95% CI: 0.16–0.54); both P < .001. Additionally, exposure to maternal HIV was significantly associated with pulmonary involvement (P = .03). Conclusions Early age at diagnosis and exposure to maternal HIV are potential predictors of aggressive JoRRP in high HIV-prevalence settings. These findings underscore the importance of integrated maternal–child healthcare, and robust public health interventions, such as expanded HPV vaccination and enhanced HIV prevention strategies, to reduce the clinical burden of JoRRP.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofaf741