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

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.