The Association of Perinatal HIV Infection and Hearing Loss in Children of Cape Town, South Africa

项目摘要 有强有力的证据表明，感染人类免疫缺陷病毒（艾滋病毒+）的儿童 有听力损失的风险。永久性听力损失的诊断很重要，因为 丧失会影响儿童的言语和语言发育。主要目标是收集 来自南非围产期感染HIV儿童的听力敏感性数据 (PHIV+).将从南非开普敦正在进行的两项研究中招募儿童： HIV感染儿童早期抗逆转录病毒治疗（CHER）试验和P1104 s研究 国际母婴青少年艾滋病临床试验（IMPAACT）。听力数据将 在PHIV+、HIV暴露但未感染（PHEU）和HIV未暴露和未感染中获得 (HU)儿童听力检查方案。听力方案包括：1）耳镜检查， 评价耳道和鼓膜; 2）鼓室导抗测试，评价中耳 功能; 3）纯音气导和骨导测听，言语测听， 测试（连同神经认知功能的测量），以评估整个听觉 畸变产物耳声发射（DPOAEs），评价耳蜗功能 内耳内;和5）听觉脑干反应（ABR），以评估听觉神经系统的功能。 在脑干水平发挥作用。先进的多模式神经成像技术，包括 结构磁共振成像（MRI），用于形态测量、基于任务和静息状态 功能磁共振成像（FMRI）评估听觉皮层功能和网络连接，以及扩散 张量成像，将用于评估艾滋病毒对不同成分的影响， 中枢听觉系统。言语测听措施也将 用于确定艾滋病毒对传播的影响。使用DPOAE、ABR和成像在 一个协议将允许检查特定的听觉刺激如何被处理 在耳蜗内，沿着听觉神经通路到达脑干，并最终到达靶向 听觉皮层的组成部分。这些措施将有助于更好地了解， 听觉系统的哪些部分更容易感染艾滋病病毒。有两个好处 这一提议。首先是与开普敦的研究人员的现有合作， 是与开普敦神经影像学专家的一项新合作;来自 CHER和P1104研究人员将允许访问广泛的人口统计数据和艾滋病毒 儿童时期的疾病和治疗数据。第二，广泛的听证协议与 一项广泛的神经成像协议将提供艾滋病毒感染儿童的首个此类数据。 这些数据将影响HIV和听力文献。

Project Abstract There is strong evidence of human immunodeficiency virus infected (HIV+) children being more at risk for hearing loss. Identification of permanent hearing loss is important because hearing loss can impact speech and language development in children. The primary goal is to collect hearing sensitivity data from South African children who were perinatally infected with HIV (PHIV+). Children will be recruited from two ongoing studies in Cape Town, South Africa: the Children with HIV Early Antiretroviral Therapy (CHER) trial and the P1104s study of the International Maternal Pediatric Adolescent AIDS Clinical Trial (IMPAACT). Hearing data will be obtained in PHIV+, HIV-exposed but uninfected (PHEU), and HIV-unexposed and uninfected (HU) children using a hearing examination protocol. The hearing protocol includes: 1) otoscopy, to evaluate the ear canal and tympanic membrane; 2) tympanometry, to evaluate middle-ear function; 3) pure-tone air- and bone-conduction audiometry, speech audiometry, dichotic digits testing (together with measures of neurocognitive function), to evaluate the entire auditory system; 4) distortion product otoacoustic emissions (DPOAEs), to evaluate cochlear function within the inner ear; and 5) auditory brainstem responses (ABRs), to evaluate auditory neural function to the level of the brainstem. Advanced multimodal neuroimaging techniques, including structural magnetic resonance imaging (MRI) for morphometry, task based and resting state functional MRI (FMRI) to assess auditory cortex function and network connectivity, and diffusion tensor imaging, will be used to evaluate the effects of HIV on the different components of the central auditory system in a comprehensive way. Speech audiometry measures will also be used to determine the impact of HIV on communication. Using DPOAEs, ABRs, and imaging in one protocol will allow for an examination of how specific auditory stimuli are processed from within the cochlea, along the auditory neural pathway to the brainstem, and finally to targeted components of the auditory cortex. These measures will contribute to a better understanding as to which portions of the auditory system are more vulnerable to HIV. There are two advantages of this proposal. First there is an existing collaboration with researchers in Cape Town and there is a new collaboration with neuroimaging experts in Cape Town; the continued support from CHER and P1104s researchers will allow for access to extensive demographic data and HIV disease and treatment data since childhood. Second, the extensive hearing protocol paired with an extensive neuroimaging protocol will provide the first of its kind data in HIV-infected children. These data will impact both the HIV and hearing literatures.