Study of Hearing and Balance in Middle Aged and Aging Men and Women in the MACS-WIHS Combined Cohort Study

摘要 根据2014年美国国民健康访谈调查，18-39岁的成年人中有5.5%的人 报告在没有助听器的情况下听力有问题。在40-69岁的成年人中，这一比例为19%。 在70岁及以上的成年人中，这一比例上升到43%，其中63%的人报告有轻度听力损失。到目前为止，有 由于缺乏艾滋病毒报告，这些艾滋病毒携带者(PLWH)的调查数据没有公布结果 状态。在一项针对HIV阳性和HIV血清阴性的中老年男性和女性的试点研究中 在华盛顿特区和巴尔的摩进行的艾滋病毒感染与低频和高频听力有关 损失。但是，需要更严格的研究，特别是在美国超过一半的PLWH超过年龄的情况下 已经50岁了。除了年龄和种族/民族在听力和平衡方面的差异，超重， 饮酒量增加、吸烟、体力活动减少、高血压和糖尿病的发生 是听力和平衡问题的常见风险因素。这些危险因素在PLWH中也可能更高。 并且有一个共同的炎症和免疫激活的特征。此外，听力和平衡 问题可能导致神经认知和身体功能障碍，这也是衰老过程中令人担忧的问题 PLWH。最后，没有关于成人艾滋病毒携带者使用听力测试应用程序的研究。评估 使用听力测试应用程序的可行性和智能手机听力测试的准确性 需要在PLWH及其HIV血清阴性的对应物中应用。我们建议解决这些差距 通过实施NHANES听证(和BALANCE问卷)的全队列管理来提高知识水平 在约4100名活跃的中老年人中进行的MACS-WIHS联合队列研究(MWCCS) 艾滋病毒携带者和非艾滋病毒携带者。在来自华盛顿特区和巴尔的摩的参与者中 网站在2009-2010年收集了基线听力和平衡数据，并在2020-2021年进行了跟踪测试，我们 建议调查免疫激活和炎症标志物的轨迹是否有助于 听力和平衡问题的进展，以及智能手机听力测试应用程序是否可能是 与HIV血清阴性患者相比，捕捉PLWH患者听力障碍的可行方法。

Abstract According to the 2014 U.S. National Health Interview Survey, 5.5% of adults aged 18-39 years old self- reported trouble with hearing without a hearing aid. Among adults 40-69 years of age, the rate was 19% increasing to 43% among adults aged 70 and over with 63% reporting mild hearing loss. To date, there has been no published results from these survey data of people living with HIV (PLWH) due to lack of reported HIV status. In a pilot study of middle-aged and aging HIV positive and HIV seronegative men and women conducted in Washington DC and Baltimore, HIV infection was associated with low and high frequency hearing loss. But, more rigorous studies are needed, especially as more than half of PLWH in the U.S. are over the age of 50 years old. Besides age and race/ethnicity differences in hearing and balance, being overweight, increased alcohol consumption, smoking, less physical activity, the occurrence of hypertension and diabetes are common risk factors for hearing and balance problems. These risk factors may also be higher in PLWH and share a common hallmark of inflammation and immune activation. Furthermore, hearing and balance problems may contribute to neurocognitive and physical dysfunction, which are also of concern in aging PLWH. Finally, there is no research on the use of hearing testing applications in adults with HIV. Evaluation of the feasibility of using a hearing testing application and the accuracy of a smartphone hearing testing application in PLWH and their HIV seronegative counterparts are needed. We propose to address these gaps in knowledge by implementing cohort-wide administration of the NHANES hearing (and balance questionnaire) in the MACS-WIHS Combined Cohort Study (MWCCS) in approximately 4,100 active middle aged and aging men and women living with and without HIV. In a subset of participants from the Washington-DC and Baltimore sites with baseline hearing and balance data collected in 2009-2010 with follow-up testing in 2020-2021, we propose to investigate whether the trajectory of markers of immune activation and inflammation contribute to progression of hearing and balance issues, and whether a smartphone hearing test application may be a feasible method to capture hearing trouble in PLWH compared to HIV seronegative participants.