title: Hearing function in patients living with HIV/AIDS.
abstract: OBJECTIVE
  During the earlier years of the HIV/AIDS epidemic, initial reports described sensorineural hearing loss in up to 49% of individuals with HIV/AIDS. During those years, patients commonly progressed to advanced stages of HIV disease and frequently had neurological complications. However, the abnormalities on pure-tone audiometry and brainstem-evoked responses outlined in small studies were not always consistently correlated with advanced stages of HIV/AIDS. Moreover, these studies could not exclude the confounding effect of concurrent opportunistic infections and syphilis. Additional reports also have indicated that some antiretroviral medications may be ototoxic; thus, it has been difficult to make conclusions regarding the cause of changes in hearing function in HIV-infected patients. More recently, accelerated aging has been suggested as a potential explanation for the disproportionate increase in complications of aging described in many HIV-infected patients; hence, accelerated aging-associated hearing loss may also be playing a role in these patients.
  
  
  METHODS
  We conducted a large cross-sectional analysis of hearing function in over 300 patients with HIV-1 infection and in 137 HIV-uninfected controls. HIV-infected participants and HIV-uninfected controls underwent a 2-hr battery of hearing tests including the Hearing Handicap Inventory, standard audiometric pure-tone air and bone conduction testing, tympanometric testing, and speech reception and discrimination testing.
  
  
  RESULTS
  Three-way analysis of variance (ANOVA) and logistic regression analysis of 278 eligible HIV-infected subjects stratified by disease stage in early HIV disease (n = 127) and late HIV disease (n = 148) and 120 eligible HIV-uninfected controls revealed no statistically significant differences among the three study groups in either overall 4-frequency pure-tone average (4-PTA) or hearing loss prevalence in either ear. Three-way ANOVA showed significant differences in word recognition scores in the right ear among groups, a significant group effect on tympanogram static admittance in both ears and a significant group effect on tympanic gradient in the right ear. There was significantly larger admittance and gradient in controls as compared to the HIV-infected group at late stage of disease. Hearing loss in the HIV-infected groups was associated with increased age and was similar to that described in the literature for the general population. Three-way ANOVA analysis also indicated significantly greater pure-tone thresholds (worse hearing) at low frequencies in HIV patients in the late stage of disease compared with HIV-uninfected controls. This difference was also found by semi-parametric mixed effects models.
  
  
  CONCLUSIONS
  Despite reports of "premature" or "accelerated" aging in HIV-infected subjects, we found no evidence of hearing loss occurring at an earlier age in HIV-infected patients compared to HIV-uninfected controls. Similar to what is described in the general population, the probability of hearing loss increased with age in the HIV-infected subjects and was more common in patients over 60 years of age. Interestingly, HIV-infected subjects had worse hearing at lower frequencies and have significant differences in tympanometry compared to HIV-uninfected controls; these findings deserve further study.
authors.affiliation: 1Infectious Diseases Division, Department of Medicine, 2Department of Otolaryngology, 3Center for Navigation and Communication Sciences, and 4Center for Integrative Bioinformatics and Experimental Mathematics, Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
authors.forename: Amneris E
authors.initials: AE
authors.lastname: Luque
authors.forename: Mark S
authors.initials: MS
authors.lastname: Orlando
authors.forename: U-Cheng
authors.initials: UC
authors.lastname: Leong
authors.forename: Paul D
authors.initials: PD
authors.lastname: Allen
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Guido
authors.forename: Hongmei
authors.initials: H
authors.lastname: Yang
authors.forename: Hulin
authors.initials: H
authors.lastname: Wu
mesh_terms: D000158:Acoustic Impedance Tests; D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D001301:Audiometry, Pure-Tone; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D015497:HIV-1; D034381:Hearing Loss / Q000453:epidemiology / Q000503:physiopathology; D006319:Hearing Loss, Sensorineural / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013063:Speech Discrimination Tests; D013069:Speech Reception Threshold Test; D055815:Young Adult