Advancing and applying peripheral and central auditory findings in HIV/AIDS.

在NIH的支持下，Ubongo Sikivu艾滋病毒携带者(PLWH)和未感染对照组的队列 在坦桑尼亚成立，并定期对他们的外周听力进行超过10年的评估 在过去5年中增加了详细的中枢听觉和神经认知评估。这群人是 独特的定位来解决PAR-20-127所提出的问题：在 NIDCD的使命。来自队列的数据已经回答了关于耳毒性的重要问题 抗逆转录病毒药物，艾滋病毒感染和治疗对外周和中枢听力参数的影响， 中枢听觉测试(CAT)结果与神经认知功能的关系。遵循这一点 关于猫如何被用来预测或跟踪神经认知表现的纵向问题 年龄和长期抗逆转录病毒治疗对听觉系统的影响可以得到回答。到目前为止， 最重要的结果是证明了CAT成绩与认知成绩相关。这 这表明CAT结果可能有助于预测或跟踪随时间推移的认知能力下降。下一个重要的 正在确定的步骤是，CAT成绩的恶化是否先于认知能力的后期发展 中枢听觉测试和其他变量中的PLWH缺陷可以预测神经认知缺陷 准确地说。神经认知筛查测试通常对教育、识字和文化很敏感。饱满 神经认知测试电池可能很难使用，特别是在发展中国家，临床医生需要 受过培训的人员很少，而且往往不存在规范性数据。使用猫将是一种 跟踪HIV+患者的主要进展，因为猫可能很矮(缺口检测测试需要5 分钟)，易于解释(噪音中的听力测试和三位数任务涉及识别单词或数字 背景噪音)，或者对受试者来说毫不费力(FFR测试根本不需要受试者输入)。这个项目的 目标是跟踪外周听觉、中枢听觉和神经认知功能随时间变化的轨迹 通过继续跟随这个队列。有了这些纵向数据，机器学习和其他统计 将使用技术来评估哪些因素预测了认知缺陷的后续发展 以及哪些因素或因素的组合可以识别出那些存在神经认知缺陷的人。一位国际人士 在PLWH具有中枢听觉测试和神经认知测试经验的团队已经组建完毕。Dr。 尼娜·克劳斯和她的西北大学团队是国际公认的听觉FFR专家。达累斯岛 Salaam团队在耳鼻喉科和执行外周听觉、中枢听觉、 和神经认知测试。罗斯博士和博伊文博士是评估神经认知功能的专家。桂博士有 多样化的生物统计学经验。尼姆扎克博士是外周和中枢听觉处理方面的专家。这 团队和纵向队列也提供了独特的能力来评估猫在评估认知方面的使用 以及衰老和药物对PLWH中枢和外周听觉功能的影响。

With NIH support, the Ubongo Sikivu cohort of both people living with HIV (PLWH) and uninfected controls was established in Tanzania and has had regular assessments of their peripheral hearing ability over 10+ years with detailed central auditory and neurocognitive assessments added over the last 5 years. This cohort is uniquely positioned to address the issues posed by PAR-20-127 “Advancing HIV/AIDS Research within the Mission of the NIDCD.” Data from the cohort has already answered important questions about the ototoxicity of anti-retrovirals, the effects of HIV infection and treatment on both peripheral and central hearing parameters, and the relationship of central auditory test (CAT) results to neurocognitive performance. By following this cohort longitudinally questions about how CATs could be used to predict or track neurocognitive performance and how age and long-term anti-retroviral treatment affect the auditory system can be answered. To date, the most significant result has been demonstrating that CAT results correlate with cognitive performance. This suggests CAT results might be useful for forecasting or tracking cognitive decline over time. The next important steps are determining whether worsening CAT performance precedes the later development of cognitive deficits in PLWH and which central auditory tests and other variables can predict neurocognitive deficits accurately. Neurocognitive screening tests are often sensitive to education, literacy, and culture. Full neurocognitive test batteries can be difficult to employ, particularly in the developing world where clinician time is limited, few trained personnel are available, and normative data often do not exist. Using CATs would be a major advance for following HIV+ patients because the CATs can be short (a gap detection test takes 5 minutes), easy to explain (the hearing-in-noise test and triple digit task involve identifying words or numbers in background noise), or effortless for the subject (the FFR test requires no subject input at all). This project’s goal is tracking the trajectory of peripheral auditory, central auditory, and neurocognitive performance over time by continuing to follow this cohort. With these longitudinal data machine learning and other statistical techniques will be applied to assess which factors forecast the subsequent development of cognitive deficits and which factors or combination of factors identify those with existing neurocognitive deficits. An international team with experience in central auditory testing and neurocognitive testing in PLWH has been assembled. Dr. Nina Kraus and her Northwestern team are internationally recognized experts in the auditory FFR. The Dar es Salaam team has extensive experience in otolaryngology and performing peripheral auditory, central auditory, and neurocognitive tests. Drs. Roth and Boivin are experts in assessing neurocognitive function. Dr. Gui has diverse biostatistical experience. Dr. Niemczak is an expert in peripheral and central auditory processing. This team and longitudinal cohort offer the unique ability to assess the use of CATs in evaluating cognition as well as the effects of aging and medications on both central and peripheral auditory function in PLWH.