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。有几个因素会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。这些因素的相对贡献尚不清楚。我们将汇集四个现有的达特茅斯/坦桑尼亚资源来研究坦桑尼亚感染艾滋病毒的成年人和儿童的听力损失：1)达达尔健康研究，这是一项由美国国立卫生研究院资助的正在进行的艾滋病毒相关结核病研究，涉及达特茅斯医学院(DMS)和穆亨比利健康与联合科学大学(MUHAS)，它将提供一大批艾滋病毒感染的成人研究对象；2)MUHAS耳鼻喉科服务，该服务定期诊断和治疗患有艾滋病毒的听力损失的艾滋病毒感染者；3)达尔达尔儿科诊所，DMS/MUHAS合作诊断和治疗艾滋病毒阳性的儿童，其中包括：1)一套由新闻部与美国国家航空航天局合作开发的基于膝上型计算机的听力测试系统，供国际空间站使用，该系统将用作实地测试仪器。这款基于笔记本电脑的电池供电设备集成了类似Bikiy的跟踪测听、失真产品耳声发射测试、探头放置验证、入耳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。该系统将增加一个基于计算机的斯瓦希里语调查问卷，涵盖听力症状和噪音暴露，以提供一个强大的系统，以便有效地进行全面的听力评估。使用这一系统，我们将通过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、接受和不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患病率研究，确定成人和儿童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阴性受试者中进行一项纵向研究，评估新的听力损失的发生率以及艾滋病毒严重程度、ART持续时间和特定的结核病治疗方案对听力损失的量化贡献。非洲制造的带有太阳能电池充电器的助听器将被提供给那些听力严重受损的受试者，这些受试者将受益于听力增强。总的来说，这些研究将：(1)提供有关艾滋病毒阳性成人和生活在资源匮乏环境中的儿童听力损失的首次全面数据；(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(中心性和外周性)的信息；(3)确定听力损失、抗逆转录病毒疗法和结核病治疗之间的联系；以及(4)允许制定监测高危受试者并通过适当治疗和听力增强进行干预的指南。

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.