Sinus Infections in People With HIV

Your head feels congested and full. The pressure behind your eyes makes it hard to concentrate. The pounding in your head and face is relentless. The dreaded sinus infection, called sinusitis, appears to affect people living with HIV more than others. While 30 percent of all people suffer a bout of sinusitis at least once each year, people with HIV seem to have it more frequently and with more severe bouts.

Man holding bridge of nose in pain
Cecile Lavabre / Getty Images

The reasons why people with HIV are prone to these infections is not clear. However, some research has suggested that HIV infection may cause changes in mucus clearance within the nasal passage, which is one of the primary defenses for the sinuses. Stripped of this protective barrier, the sinus tissues may be more prone to infection and inflammation.

While it is clear that HIV itself does not cause breathing disorders, it can reduce a person's immune strength, making even minor infections worse. Even those with relatively good immune function, sinusitis can develop as a result of the chronic inflammation associated with long-term HIV infection.


The sinuses are simply individual pockets of air located inside the bones of the skull. They are situated to either side of the nose (maxillary); behind and in between the eyes (ethmoid); in the forehead (frontal); and further back in the head (sphenoid). These breathing spaces contain mucus, which drains by way of small pinholes on the surfaces of the sinuses.

As a result of allergies or colds, these small holes can get plugged, preventing the mucus from draining properly. As the mucus builds up, pressure builds and causes pain. In addition, the mucosal discharge becomes a perfect breeding ground for bacterial growth, eventually leading to infection.

Acute sinusitis can last four weeks or more, while chronic sinusitis can last twelve weeks or more.

Signs and Symptoms

There are several signs and symptoms that indicate you have a sinus infection. Most people with sinusitis will complain about:

  • Pain and pressure near the cheekbones, the jawline, and teeth; above and behind the eyes; and in the head.
  • An increase in pain when the healthcare provider lightly taps over the area over the sinuses with his or her fingertips.
  • As the infection worsens, fever may develop, accompanied by nasal discharge, head congestion, ear pain, and a diminished sense of smell.


Acute sinusitis often resolves on its own with no treatment. When treated, antibiotics are typically prescribed for 10 to 14 days. It is important to complete the course of antibiotic treatment, as stopping them prematurely can lead to bacterial resistance.

Oral and topical decongestants also may be prescribed to alleviate symptoms. In some people with recurrent or chronic sinus infections, sinus surgery may be indicated if the constrained breathing interferes with day-to-day life. In such cases, the sinuses will have to be cleaned out surgically, removing accumulated mucus and infection while enlarging the drain hole to allow for better sinus drainage.

How to Relieve Your Symptoms

Until the sinus infection is resolved, the symptoms can be incredibly uncomfortable and annoying. However, there are several ways to ease the symptoms, including:

  • Increasing warm, moist air in your room with a humidifier.
  • Placing warm, moist compresses to painful areas of your face.
  • Using saline nose drops to relieve dryness and congestion.
  • Using over-the-counter decongestants to relieve nasal pressure.
  • Using over-the-counter nasal sprays to reduce congestion (although they should be used for no more than three days in order to avoid dependence and/or a worsening of symptoms).

If you are having problems with recurrent sinus infections or are unable to cope with an acute case of sinusitis, talk to your healthcare provider. With accurate diagnosis, sinusitis can be treated effectively and prescribed medications which may be more effective than over-the-counter versions.

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By Mark Cichocki, RN
Mark Cichocki, RN, is an HIV/AIDS nurse educator at the University of Michigan Health System for more than 20 years.