Hearing function in patients living with HIV/AIDS.
Hearing function in patients living with HIV/AIDS.
复制标题
DOI：
10.1097/aud.0000000000000064
复制
发表时间：
2014-11
期刊：
影响因子：
3.7
通讯作者：
Wu H
中科院分区：
文献类型：
--
作者：
Luque AE;Orlando MS;Leong UC;Allen PD;Guido JJ;Yang H;Wu H
在艾滋病毒/艾滋病流行的前几年，最初的报告描述了高达49%的艾滋病毒/艾滋病患者的感觉神经性听力损失。在这些年里，患者通常发展到艾滋病毒疾病的晚期，并经常出现神经并发症。然而，在小型研究中概述的纯音测听和脑干诱发反应的异常并不总是与艾滋病毒/艾滋病的晚期相一致。此外，这些研究不能排除同时发生机会性感染和梅毒的混杂影响。更多的报告也表明，一些抗逆转录病毒(ARV)药物可能是耳毒性的，因此很难就HIV感染患者听力功能变化的原因得出结论。最近，加速衰老被认为是许多HIV感染患者衰老并发症不成比例增加的潜在原因，因此加速衰老相关的听力损失也可能在这些患者中发挥作用。我们对300多名HIV-1感染患者和137名未感染HIV的对照组进行了听力功能的大型横断面分析。感染艾滋病毒的参与者和未感染艾滋病毒的对照组接受了两个小时的听力测试，包括听力残疾指数、标准的纯音空气和骨传导测试、鼓室测试以及语言接收和辨别测试。对278例符合条件的HIV感染者(按疾病早期(n=127)和晚期(n=148))和120例符合条件的非感染者(n=148)进行单因素方差分析和Logistic回归分析，结果显示三个研究组在总体4-PTA或双耳听力损失发生率方面均无统计学差异。三因素方差分析显示右耳单词再认分数(WRS)组间差异显著，双耳鼓室导纳的组效应显著，右耳鼓室梯度的组效应显著。在疾病晚期，与HIV感染组相比，对照组有更大的入院和梯度。HIV感染人群中的听力损失与年龄增加有关，与文献中描述的普通人群的听力损失相似。三因素方差分析还表明，与未感染艾滋病毒的对照组相比，疾病晚期的艾滋病毒患者在低频下的纯音阈值(听力更差)显著更高。这种差异也被半参数混合效应(SPME)模型发现。尽管有报道称艾滋病毒感染者“过早”或“加速”衰老，但我们没有发现证据表明，与未感染艾滋病毒的对照组相比，艾滋病毒感染者的听力损失发生在更早的年龄。与普通人群的描述类似，在艾滋病毒感染者中，听力损失的概率随着年龄的增加而增加，在60岁以上的患者中更为常见。有趣的是，感染艾滋病毒的受试者在频率较低时听力较差，与未感染艾滋病毒的对照组相比，鼓室导纳有显著差异；这些发现值得进一步研究。
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 (ARV) 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. 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 two-hour 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. Three-way 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 statistical significant differences among the three study groups in either overall 4-PTA or hearing loss prevalence in either ear. Three-way ANOVA showed significant differences in word recognition scores (WRS) 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 (SPME) models. 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.