Central auditory processing in HIV-positive individuals

描述(申请人提供)：艾滋病毒阳性者可能会出现听力障碍，但问题的位置(例如中耳、耳聋、中枢神经系统(CNS))及其与治疗的关系尚不清楚。我们正在坦桑尼亚进行的由NIDCD资助的研究结果表明，接受抗逆转录病毒治疗(ART)的患者的发现与中枢听觉处理障碍一致。这表明：(A)艾滋病毒阳性个体的听力障碍可能是艾滋病毒感染的另一个神经认知副作用，(B)某些抗逆转录病毒疗法可能会产生中枢神经系统副作用，表现为听力障碍，(C)某些抗逆转录病毒疗法可能对中枢神经系统艾滋病毒治疗不当，这反映为中枢性听力障碍，和/或(D)监测中枢听力参数可能是追踪艾滋病毒或抗逆转录病毒疗法的中枢影响的一种方法。这些发现需要得到证实、扩展，并与特定的治疗方案明确相关。这项研究的目的是评估上海中国艾滋病主要治疗地点的一大批艾滋病毒感染者的中枢听觉处理(如间隙检测阈值、听性脑干反应、噪声中语音阈值)。将这一听力测试方案与上海接受治疗的人群相结合，将提供一个强大的组合，来回答有关艾滋病毒患者中央处理障碍的问题，并将结果与特定的药物方案联系起来。我们的研究将使用基于笔记本电脑的听力测试系统，其中包括：自我报告听力能力和接触噪音、药物和毒素的母语问卷管理；阈值测听；自适应间隙检测测试；普通话噪音中语音测试；鼓室测试；以及听性脑干反应测试，以评估脑干通路。测试将在上海公共卫生临床中心进行，上海艾滋病治疗中心中国。该中心跟踪2000名艾滋病患者，提供门诊和住院治疗，隶属于复旦大学，在艾滋病毒研究方面有着良好的记录。我们将在中心放置两个综合听力测试系统，并提供测试培训。HIV阴性、未接受抗逆转录病毒治疗的艾滋病毒阳性患者和接受各种不同抗逆转录病毒疗法的艾滋病毒阳性患者将被纳入研究，并采用以中央听觉处理为重点的方案进行研究。听力测试系统与上海研究经验丰富的大容量诊所相结合，将提供一个极好的环境，以确认和扩大对艾滋病毒感染中的中枢听觉处理缺陷的了解，并确定这些发现是否与感染持续时间或特定的ART方案有关。这项研究的信息可能会改变对艾滋病毒阳性患者的监测和治疗方式。为检测中枢听觉处理缺陷而开发的新方法，如自适应间隙检测算法，可能有助于检测和跟踪HIV阳性患者的神经认知变化。

DESCRIPTION (provided by applicant): HIV positive individuals can develop hearing difficulties, but the location of the problem (e.g. middle ear, cochlea, central nervous system (CNS)) and the relationship to treatment has not been known. Results from our ongoing NIDCD-funded study in Tanzania show that patients on anti-retroviral therapy (ART) have findings consistent with a central auditory processing disorder. This suggests that (a) hearing deficits in HIV-positive individuals could be another neurocognitive side effect of HIV infection, (b) certain ART regimens might produce central nervous system side effects that manifest themselves as hearing difficulties, (c) some ART regimens may treat CNS HIV inadequately, which is reflected as a central hearing deficit, and/or (d) monitoring of central hearing parameters could be a method to track central effects of either HIV or ART. These findings need to be confirmed, expanded, and related definitively to particular treatment regimens. The objective of the proposed study is to assess central auditory processing (e.g. gap detection thresholds, auditory brainstem response, speech-in-noise thresholds) in a large cohort of HIV positive individuals at the main AIDS treatment site in Shanghai China. The combination of this audiological testing protocol, with the population under treatment in Shanghai, will provide a powerful combination to answer questions about central processing disorders in patients with HIV and to relate the findings to particular drug regimens. Our study will use a laptop-based hearing testing system that includes: native-language questionnaire administration for self-reported hearing capability and exposure to noise, drugs and toxins; threshold audiometry; adaptive gap detection testing; speech-in-noise testing in Mandarin; tympanometry; and auditory brainstem response testing to assess brainstem pathways. Testing will take place at the Shanghai Public Health Clinical Center--the AIDS treatment center for Shanghai, China. The center follows 2000 AIDS patients, offers both outpatient and inpatient treatment, is affiliated with Fudan University, and has a strong record of HIV research. We will place two integrated hearing testing systems at the center, and provide training in performing the testing. HIV negative, HIV positive individuals not on ART, and HIV positive individuals on a variety of different ART regimens will be enrolled, and studied with a central-auditory-processing-focused protocol. The combination of the hearing testing systems with the research-experienced, high-volume clinic in Shanghai, will provide an excellent environment to confirm and expand knowledge about the central auditory processing deficits in HIV infection, and ascertain whether these findings are related to the duration of infection or particular ART regimens. The information from this study may change how HIV positive are monitored and treated. The new methods developed for detecting central auditory processing deficits, such as the adaptive gap detection algorithm, may be useful for detecting and tracking neurocognitive changes in HIV positive patients.