HIV infection, seasonality and younger age predicting incident Bell's palsy among black South Africans

Dali Magazi; Benjamin Longombenza; Siyazi Mda; Kees Van der Meyden; Marcus Motshwane; Mirabel Nanjoh; Olakunle Towobola

doi:10.1186/s12883-020-01965-0

HIV infection, seasonality and younger age predicting incident Bell's palsy among black South Africans

BMC Neurol. 2020 Oct 21;20(1):381. doi: 10.1186/s12883-020-01965-0.

Authors

Dali Magazi¹, Benjamin Longombenza², Siyazi Mda³, Kees Van der Meyden⁴, Marcus Motshwane⁵, Mirabel Nanjoh⁶, Olakunle Towobola⁷

Affiliations

¹ Department of Neurology, Sefako Makgatho Health Sciences University, Pretoria, South Africa. dmagazi@profmagazi.co.za.
² Department of Internal Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
³ Department of Paediatrics, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
⁴ Department of Neurology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
⁵ Department of statistics, Tshwane University of technology, Pretoria, South Africa.
⁶ Faculty of health Sciences, Walter Sisulu University, Mthatha, South Africa.
⁷ Department of Internal Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa.

Abstract

Background: Although South Africa (SA) is facing a high prevalence of HIV infection, there is no literature from this region on a link between Bell's palsy and HIV. The aim of this study was to identify the occurrence of Bell's palsy in relation to demographics, seasons and HIV status among black South Africans.

Methods: This retrospective cohort was conducted among adult black patients, without Bell's palsy in 2003, presenting to the neurology outpatients department at Dr. George Mukhari Academic hospital, Pretoria, South Africa, between 2004 (study baseline) and 2012 (end test). Gender, age, HIV status, and seasons were potential predictors of Bell's palsy using Cox regression model and Kaplan Meier curves.

Results: From the baseline of 1487 patients, 20.9% (n = 311) experienced Bell's palsy onset by the end of the study. In univariate analysis, male gender (RR = 2.1 95% CI 1.7-2.5; P < 0.0001), age less than 30 years (RR = 2.9 95% CI 2.4-3.6; P < 0.0001), HIV seropositivity (RR =2.9 95% CI 2.3-4.9; P < 0.0001). The highest incidence in winter (30.3% n = 136/450) vs. incidences during other seasons with Intermediate values during Summer (25.3% n = 136/450) and Autumn (20.7% n = 64/308) and the lowest incidence in Spring (23.7% n = 16/353) P < 0.0001) were predictors of Bell's palsy. In multivariate analysis at adjusting for gender, the most significant and independent predictors of incident Bell's palsy were HIV seropositivity (HR = 6.3 95% CI 4.8-8.3; P < 0.0001), winter (HR = 1.6 95% CI 1.2-2.1; P < 0.0001) vs. other seasons, and younger age < 30 years (HR = 7.1 95% CI 5.6-9.1; P < 0.0001) vs. older age groups.

Conclusion: Seasonality, younger age and HIV positivity are important and independent risk factors of Bell's palsy. Education and awareness programs on the possible effects of HIV and seasons on the development of Bell's palsy are necessary. This would lead to a better understanding and even a possible development of avoidance measures for this condition amongst young black South Africans.

Keywords: Bell’s palsy; HIV; Males; Seasons; South Africa; Young age.

MeSH terms

Adult
Age Factors
Bell Palsy* / complications
Bell Palsy* / epidemiology
Black People / statistics & numerical data*
Female
HIV Infections* / complications
HIV Infections* / epidemiology
Humans
Male
Retrospective Studies
Seasons
South Africa / epidemiology
Young Adult