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，感染艾滋病毒(HIV+)的儿童 有听力损失的风险。永久性听力损失的识别很重要，因为听力 缺失会影响儿童的言语和语言发展。主要目标是收集 南非围产期感染艾滋病毒儿童的听力敏感性数据 (PHIV+)。儿童将从南非开普敦正在进行的两项研究中招募： 儿童HIV早期抗逆转录病毒治疗(CHER)试验和P1104s研究 国际母婴青少年艾滋病临床试验(IMPAACT)听证数据将是 在PHIV+、艾滋病毒暴露但未感染(PHEU)和艾滋病毒未暴露和未感染中获得 (HU)使用听力检查方案的儿童。听诊方案包括：1)耳镜检查， 评估耳道和鼓膜；2)鼓室导纳，评估中耳 功能：3)纯音气导和骨导测听、言语测听、双指测听 测试(连同神经认知功能的测量)，以评估整个听觉 系统；4)失真产物耳声发射(DPOAEs)，以评估耳蜗功能 以及5)听觉脑干反应(ABR)，以评估听神经 功能达到脑干的水平。先进的多模式神经成像技术，包括 用于形态测量、基于任务和静息状态的结构磁共振成像(MRI) 功能磁共振成像(FMRI)评估听觉皮质功能、网络连通性和扩散 张量成像，将被用来评估艾滋病毒对脑内不同成分的影响 中枢听觉系统的综合方式。言语测听措施也将 用来确定艾滋病毒对交流的影响。使用DPOAE、ABR和映像 一种方案将允许检查特定的听觉刺激是如何从 在耳蜗内，沿着听觉神经通路到达脑干，最后到达靶点 听觉皮质的组成部分。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毒。它有两个优势 这项提议。首先是与开普敦和那里的研究人员现有的合作 是与开普敦的神经成像专家的新合作；来自 Cher和P1104的研究人员将允许访问广泛的人口数据和艾滋病毒 儿童时期以来的疾病和治疗数据。第二，广泛的听证协议与 一项广泛的神经成像方案将在感染艾滋病毒的儿童中提供首个此类数据。 这些数据将对艾滋病毒和听力文献产生影响。

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.