Response of lymphoepithelial parotid cysts to antiretroviral treatment in HIV-infected adults

Background: Surgical resection has been the usual therapy for HIV-infected patients with lymphoepithelial parotid cysts. Objective: To study antiretroviral therapy for lymphoepithelial parotid cysts. Design: Case series. Setting: HIV outpatient clinics. Patients: HIV-infected patients with lymphoepithelial parotid cysts. Intervention: Antiretroviral therapy. Measurements: Change in size of the parotid cyst, CD4 lymphocyte count, and HIV viral load. Results: Nine HIV-infected adults presented with chronic, large parotid cysts, eight of which were bilateral. in at least seven patients, the cysts were the initial sign of HIV infection. In six patients, the cysts resolved completely with combination antiretroviral therapy. Four of these patients also received prednisone. Three patients who did not comply with antiretroviral therapy had partial responses followed by relapses. Conclusions: Parotid cysts are an unrecognized sign of early HIV infection. These cysts respond to combination antiretroviral therapy, with or without corticosteroids. Surgical resection should be reserved for patients in whom medical therapy has failed or those who refuse or are poorly compliant with medical therapy.