Clinical Report: Severe Juvenile-Onset Respiratory Papillomatosis in High HIV-Prevalence South Africa

Overview

This study analyzed 277 juvenile-onset recurrent respiratory papillomatosis (JoRRP) patients in KwaZulu-Natal, South Africa, revealing a prevalence of 4.17 per 100,000 and an incidence of 3.82 per 100,000 live births. Early diagnosis (≤2 years) and exposure to maternal HIV were significantly associated with aggressive disease and pulmonary involvement, highlighting critical clinical predictors in this high HIV-burden setting.

Background

Juvenile-onset recurrent respiratory papillomatosis (JoRRP) is a chronic pediatric disease caused by HPV types 6 and 11, characterized by recurrent papillomas in the respiratory tract. Transmission primarily occurs vertically during vaginal delivery, with maternal HPV infection increasing risk. Aggressive JoRRP involves rapid papilloma growth, frequent surgeries, and potential lower airway spread, leading to increased morbidity. KwaZulu-Natal, South Africa, has high HIV prevalence, which may influence JoRRP severity and outcomes.

Data Highlights

Key Findings

• JoRRP incidence and prevalence in KwaZulu-Natal are higher than global averages, with 3.82 per 100,000 live births and 4.17 per 100,000 population respectively.
• Half of the patients exhibited aggressive disease, defined by frequent surgical interventions and potential airway spread.
• Children diagnosed at or before 2 years of age had significantly higher odds of aggressive JoRRP compared to older children.
• Exposure to maternal HIV was significantly associated with pulmonary involvement, indicating more severe disease manifestations.
• Early age at diagnosis and maternal HIV exposure are important clinical predictors of disease severity in this high HIV-prevalence setting.

Clinical Implications

Clinicians in high HIV-prevalence regions should maintain heightened vigilance for JoRRP in young children, especially those exposed to maternal HIV, to identify aggressive disease early. Integrated maternal-child healthcare and targeted public health interventions, including expanded HPV vaccination and HIV prevention, are essential to reduce JoRRP burden. Early diagnosis and tailored management can improve outcomes and optimize resource allocation in resource-limited settings.

Conclusion

This study underscores early age at diagnosis and maternal HIV exposure as key predictors of aggressive JoRRP in KwaZulu-Natal, South Africa. These findings support integrated prevention strategies and early clinical intervention to mitigate disease severity in high HIV-burden regions.

References

1. Global Health and Infectious Diseases, Major Article -- Severe Juvenile-Onset Respiratory Papillomatosis in Regions with High HIV Rates: Identifying Clinical Indicators of Severity in South Africa