Sinusitis (swelling of the sinuses in the nasal cavity) strikes 68 percent of positive people—compared with 14 percent of the general U.S. population—leaving them wheezing, snuffling and aching. But for scientists, it seems a low priority: Of the 2,642 presentations at the 2007 International AIDS Conference in Sydney, not one concerned sinusitis in HIV-positive people.

Sinusitis expert Thomas Tami, MD, of Cincinnati’s Sinus Institute, says a possible reason the condition is so common among positive people is that HIV raises blood levels of a protein connected with allergies. HIV also seems to thicken mucus, Tami says, making it harder to clear nasal passages and creating “more tenacious” sinus ills.

When CD4 counts drop below 200, AIDS-related infections often produce more stubborn, painful infections, some resistant to treatment. But if your HIV is well controlled, you’ll get the same sinusitis treatment as negative folks: a first-line of attack with antibiotics, because most cases in healthy people stem from bacterial infections.

If the antibiotics don’t knock out the infection in a week or two, next is either a broader-scope antibiotic or “culture-directed therapy”—your doc analyzes a sample of your infection to identify the exact germ causing it, then prescribes the appropriate medicine.

For cases that won’t quit, surgical options exist. Short of that, your doc may prescribe steroids and other drugs to quell chronic inflammation. Decongestants can help; so can home remedies like salt-water flushing to clear passages. “Twice a day I snort prescription nasal spray,” says Michael Connidis, who’s had HIV for 22 years and sinusitis for nine. “It limits the lovely hawking and honking.”