Risk factors associated with severe recurrent respiratory papillomatosis

BACKGROUND: Recurrent respiratory papillomatosis can present with a highly variable clinical course. The disease can cause serious morbidity and can be fatal because of airway obstruction. We examined whether the age of onset, gender, human immunodeficiency virus (HIV) infection and dysplasia on analysis of histological specimens were predictive of an aggressive disease course. OBJECTIVES: To conduct an audit of all patients presenting with Recurrent Respiratory Papillomatosis at our institution and to determine if an earlier age of onset, gender, HIV and dysplasia are predictive factors for an aggressive disease course. METHODS: A total of 202 clinical records and histological reports were reviewed at a quaternary-level hospital in Durban, South Africa. The disease was defined as juvenile onset (< 18 years) or adult onset (≥ 18 years). Aggressive disease was defined as a disease requiring 10 or more surgical debulkings in total and or extralaryngeal papilloma. RESULTS: A total of 184 patients were of juvenile onset and 18 were of adult onset. In the juvenile onset group, a total of 97 patients (52.8%) had aggressive disease. In the juvenile onset group, a later age of onset was associated with less aggressive disease (odds ratio [OR] = 0.77, p < 0.05). There were 20 (10.9%) HIV-positive patients. HIV infection was a predictor of aggressive disease (OR = 3, p < 0.029). Analysis of histological reports revealed that 39 (21.2%) of patients had dysplasia. Dysplasia was a predictor of aggressive disease (OR = 9.96, p < 0.05%). In the adult onset group, only two patients (11.1%) had aggressive disease. CONCLUSION: An earlier age of onset, HIV infection and dysplasia were predictors of aggressive disease in the juvenile onset group.