Hearing impairment in HIV-infected and HIV/TB-coinfected individuals in Tanzania

描述（由申请人提供）：有限的数据表明，艾滋病毒感染及其治疗与听力损失有关。有几个因素可以影响艾滋病毒感染者的听力，包括艾滋病毒本身，继发感染和药物治疗。这些因素的相对作用尚不清楚。我们将汇集四个已建立的达特茅斯/坦桑尼亚资源，研究坦桑尼亚艾滋病毒感染成人和儿童的听力损失：1）DarDar健康研究，一项正在进行的由NIH资助的艾滋病毒相关结核病研究，涉及达特茅斯医学院（DMS）和Muhimbili健康与联合科学大学（MUHAS），该研究将提供一个大型的艾滋病毒感染成人研究受试者队列，2）MUHAS耳鼻喉服务，对患有听力损失的艾滋病毒感染者进行常规诊断和治疗，3）DarDar儿科诊所，这是DMS/MUHAS合作诊断和治疗艾滋病毒阳性儿童的一个诊所，跟踪越来越多的艾滋病毒阳性和受艾滋病毒影响的儿童，4）一个基于笔记本电脑的诊所，由DMS与美国国家航空航天局合作开发的用于国际空间站的听力测试系统，将用作现场测试设备。这款电池供电、基于笔记本电脑的设备结合了Bikisy式跟踪测听、畸变产物耳声发射测试、探头放置验证、耳内噪声水平测量和间隙检测测试。它非常适合在资源有限的环境中评估听力损失。将在该系统中增加一个以计算机为基础的斯瓦希里语问卷，其中包括听力症状和噪音暴露，以提供一个有效进行全面听力评估的强大系统。使用这个系统，我们将确定在坦桑尼亚的艾滋病毒阳性受试者接受和不接受抗逆转录病毒治疗（ART），艾滋病毒阳性受试者和不接受结核病治疗，艾滋病毒阴性对照之间进行横断面流行率研究的频率异常的中央和外周听力测试结果在成人和儿童。我们还将在HIV阳性和HIV阴性受试者的纵向研究中评估新发听力损失的发生率以及HIV严重程度、ART持续时间和特定TB治疗方案对听力损失的定量贡献。非洲制造的带有太阳能电池充电器的助听器将提供给那些严重听力损失的受试者，这些受试者将受益于听力增强。总的来说，这些研究将：（1）提供关于生活在资源匮乏环境中的艾滋病毒阳性成人和儿童听力损失的第一个全面数据，（2）提供关于听力损失的患病率、发生率和性质的信息，（3）确定听力损失、ART和TB治疗之间的关联，以及（4）允许制定用于监测高危受试者并进行适当治疗和听力增强干预的指南。

DESCRIPTION (provided by applicant): Limited data suggest that HIV infection and its treatment are associated with hearing loss. Several factors can affect hearing in those infected with HIV including HIV itself, secondary infections, and medications. The relative contribution of these factors is not known. We will bring together four established Dartmouth/Tanzanian resources to study hearing loss among both HIV-infected adults and children in Tanzania: 1) the DarDar Health Study, an ongoing NIH-funded study of HIV-associated tuberculosis involving Dartmouth Medical School (DMS) and the Muhimbili University of Health and Allied Sciences (MUHAS), which will provide a large cohort of HIV-infected adult study subjects, 2) the MUHAS ENT service, which routinely diagnoses and treats HIV-infected individuals with hearing loss, 3) the DarDar pediatric clinic, a DMS/MUHAS collaboration to diagnose and treat HIV-positive children, which follows a growing cohort of HIV-positive and HIV-affected children and 4) a laptop computer- based, hearing-testing system developed by DMS in collaboration with the National Aeronautics and Space Administration for use on the International Space Station, which will be used as the field testing apparatus. This battery-powered, laptop-based device incorporates Bikisy-like tracking audiometry, distortion-product otoacoustic emission testing, probe placement verification, in-ear noise level measurement, and a gap detection test. It is ideally suited for assessing hearing loss in resource-limited environments. A computer-based, Kiswahili questionnaire that covers hearing symptoms and noise exposure will be added to the system to provide a robust system for performing complete hearing evaluations efficiently. Using this system we will determine the frequency of abnormal central and peripheral hearing test results in both adults and children by performing a cross-sectional prevalence study in Tanzania among HIV-positive subjects receiving and not receiving anti-retroviral therapy (ART), HIV-positive subjects with and without prior treatment for TB, and HIV-negative controls. We will also assess the incidence of new hearing loss and the quantitative contributions of HIV severity, ART duration and specific TB treatment regimens to hearing loss in a longitudinal study among HIV-positive and HIV-negative subjects. African-made hearing aids with solar battery chargers will be provided to those subjects with significant hearing loss that would benefit from hearing augmentation. Collectively, these studies will: (1) provide the first comprehensive data on hearing loss among HIV-positive adults and children living in a resource poor setting, (2) provide information on the prevalence, incidence and nature (central vs. peripheral) of the hearing loss in HIV-positive subjects, (3) determine associations between hearing loss, ART and TB treatment, and (4) permit the development of guidelines for monitoring high-risk subjects and intervening with appropriate treatment and hearing augmentation.