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HIV感染及其治疗与听力损失有关。有几个因素会影响HIV感染者的听力，包括HIV本身、继发感染和药物。这些因素的相对作用尚不清楚。我们将汇集达特茅斯/坦桑尼亚的四项既定资源，研究坦桑尼亚感染艾滋病毒的成人和儿童的听力损失：1) DarDar健康研究，一项正在进行的由美国国立卫生研究院资助的关于艾滋病相关结核病的研究，涉及达特茅斯医学院（DMS）和Muhimbili卫生与联合科学大学（MUHAS），该研究将提供大量感染艾滋病毒的成人研究对象；2)MUHAS耳喉科服务，常规诊断和治疗听力损失的艾滋病毒感染者；3)DarDar儿科诊所，DMS/MUHAS合作，诊断和治疗艾滋病毒阳性儿童。4) DMS与美国国家航空航天局合作开发了一套基于笔记本电脑的听力测试系统，用于国际空间站，该系统将被用作实地测试设备。这款基于笔记本电脑的电池供电设备结合了bikisy式跟踪测听、失真产品耳声发射测试、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份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情况，以提供一个强有力的系统，以便有效地进行全面的听力评估。利用该系统，我们将在坦桑尼亚对接受和未接受抗逆转录病毒治疗（ART）的艾滋病毒阳性受试者、接受和未接受结核病治疗的艾滋病毒阳性受试者以及艾滋病毒阴性对照进行横断面流行研究，以确定成人和儿童中中枢和外周听力测试结果异常的频率。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、抗逆转录病毒治疗持续时间和特定结核病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听力损失严重的人，他们将从助听器中受益。总的来说，这些研究将：(1)提供有关生活在资源贫乏环境中的艾滋病毒阳性成人和儿童听力损失的第一个综合数据；(2)提供有关艾滋病毒阳性受试者听力损失的患病率、发病率和性质（中枢与外周）的信息；(3)确定听力损失、抗逆转录病毒治疗和结核病治疗之间的关系；(4)允许制定监测高风险受试者并通过适当治疗和助听器进行干预的指南。

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.