Alterations of nasal mucociliary clearance in association with HIV infection and the effect of guaifenesin therapy

Objectives: To determine if human immunodeficiency virus (HIV) infection is associated with a prolonged mucociliary clearance time (MCT) and to evaluate the effect of guaifenesin on MCT in HIV+ patients. Study Design: A cross-sectional study comparing HIV+ and HIV- volunteers followed by a prospective, randomized, double-blind, placebo-controlled study of HIV+ patients before and after guaifenesin treatment. Methods: Twenty-five HIV+ patients and 29 HIV- controls were enrolled and MCT was measured using the saccharin method. A separate group of 20 HIV+ patients participated in the second arm of the study and underwent saccharin testing before and after a 3-week course of guaifenesin or placebo. All study participants completed a medical history questionnaire, a sinonasal symptom (SNOT-16) survey, and were examined with both anterior rhinoscopy and rigid nasal endoscopy. Results: There was a significant difference (F < .002) in the MCT between the HIV+ group (13.3 ± SD 7.5 minutes) and the HIV- controls (9.2 ± SD 3.9 minutes). The difference in MCT between the guaifenesin and placebo groups did not reach statistical significance (P > .05). The HIV+ group had a higher SNOT-16 score compared to HIV- controls (21.1 vs. 7.4, P < .001). Guaifenesin therapy in HIV+ patients led to a significant improvement in the SNOT-16 score (P < .05). Conclusions: Compared to HIV- controls, HIV+ patients have a prolonged MCT and more sinonasal symptoms as indicated by a higher SNOT-16 score. Guaifenesin therapy was associated with improved SNOT-16 scores, although there was not a detectable improvement in MCT. Use of guaifenesin in HIV+ patients with sinonasal disease may lead to improved patient perception of quality of life.