Auditory impairments in HIV-infected individuals in Tanzania.
OBJECTIVE
Abnormal hearing tests have been noted in human immunodeficiency virus (HIV)-infected patients in several studies, but the nature of the hearing deficit has not been clearly defined. The authors performed a cross-sectional study of both HIV+ and HIV- individuals in Tanzania by using an audiological test battery. The authors hypothesized that HIV+ adults would have a higher prevalence of abnormal central and peripheral hearing test results compared with HIV- controls. In addition, they anticipated that the prevalence of abnormal hearing assessments would increase with antiretroviral therapy (ART) use and treatment for tuberculosis (TB).


METHODS
Pure-tone thresholds, distortion product otoacoustic emissions (DPOAEs), tympanometry, and a gap-detection test were performed using a laptop-based hearing testing system on 751 subjects (100 HIV- in the United States, plus 651 in Dar es Salaam, Tanzania, including 449 HIV+ [130 ART- and 319 ART+], and 202 HIV-, subjects. No U.S. subjects had a history of TB treatment. In Tanzania, 204 of the HIV+ and 23 of the HIV- subjects had a history of TB treatment. Subjects completed a video and audio questionnaire about their hearing, as well as a health history questionnaire.


RESULTS
HIV+ subjects had reduced DPOAE levels compared with HIV- subjects, but their hearing thresholds, tympanometry results, and gap-detection thresholds were similar. Within the HIV+ group, those on ART reported significantly greater difficulties understanding speech in noise, and were significantly more likely to report that they had difficulty understanding speech than the ART- group. The ART+ group had a significantly higher mean gap-detection threshold compared with the ART- group. No effects of TB treatment were seen.


CONCLUSIONS
The fact that the ART+/ART- groups did not differ in measures of peripheral hearing ability (DPOAEs, thresholds), or middle ear measures (tympanometry), but that the ART+ group had significantly more trouble understanding speech and had higher gap-detection thresholds indicates a central processing deficit. These data suggest that: (1) hearing deficits in HIV+ individuals could be a CNS side effect of HIV infection, (2) certain ART regimens might produce CNS side effects that manifest themselves as hearing difficulties, and/or (3) some ART regimens may treat CNS HIV inadequately, perhaps due to insufficient CNS drug levels, which is reflected as a central hearing deficit. Monitoring of central hearing parameters could be used to track central effects of either HIV or ART.
1DarDar Health Study, Dar es Salaam, Tanzania; 2Department of Otolaryngology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 3Creare, Inc., Hanover, New Hampshire, USA; 4Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; 5Harvard Medical School, Boston, Massachusetts, USA; 6Department of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and 7Department of Speech, Language and Hearing Sciences, University of Connecticut, Storrs, Connecticut, USA.
Isaac I
II
Maro
Ndeserua
N
Moshi
Odile H
OH
Clavier
Todd A
TA
MacKenzie
Robert J
RJ
Kline-Schoder
Jed C
JC
Wilbur
Robert D
RD
Chambers
Abigail M
AM
Fellows
Benjamin G
BG
Jastrzembski
John E
JE
Mascari
Muhammad
M
Bakari
Mecky
M
Matee
Frank E
FE
Musiek
Richard D
RD
Waddell
C Fordham
CF
von Reyn
Jay C
JC
Buckey
D000158:Acoustic Impedance Tests; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D034381:Hearing Loss / Q000150:complications / Q000503:physiopathology*; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D017084:Otoacoustic Emissions, Spontaneous / Q000502:physiology*; D013067:Speech Perception / Q000502:physiology*; D013636:Tanzania; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy*; D014481:United States; D055815:Young Adult
D000995:Antitubercular Agents