Laburpena
Background: The role of viral load level and/or CD4 (Cluster of differentiation 4) cell count in the aetiopathogenesis of hearing loss in HIV infection is unclear. Therefore, we investigated the relationship between CD4 cell counts, viral load and hearing threshold of HIV (Human immunodeficiency virus) infected adults.
Methods: This cohort audiometric study involved consecutive HIV-infected and HIV-uninfected adults as controls. Clinical data relating to hearing loss, HIV status, and highly active antiretroviral therapy (HAART) were obtained. Audiometric evaluation was performed. The most recent CD4 cell counts and RNA viral load of HIV-infected participants were obtained from clinic records.
Results: There were 299(66.7%) HIV-infected adults and 149(33.3%) controls with mean age of 39.6412.45 years and 39.60+12.45 years respectively (p=0.98). In both groups, there were more participants with left hearing loss. Mild to profound hearing loss was found in 65.9% HIV-infected participants and 53.7% controls. Majority (86.3%) of the HIVinfected participants were on HAART. The mean CD4 cell count was 654.58+289.15 in 41 HIV-infected participants not on HAART and 523.95+300.17 in 258 participants on HAART (p=0.01). Majority, 197 (62%) HIV-infected participants
with hearing loss had CD4 cell count <200 cells/mm3 . Higher viral load significantly correlated with low CD4 cell counts (p<0.01; r=0.18) and low CD4 cell count significantly correlated with high hearing threshold (p<0.01; r=0.17).
Conclusion: There was a trend towards more hearing loss among the HIV-infected adults. The higher hearing threshold in those with low CD4 cell counts of <200 cells/mm3 suggests possible relationship between hearing status and severity of HIV disease.
Keywords: CD4+ cell counts, hearing loss, hearing threshold, HIV, pure tone audiometry, viral loads
Résumé
Contexte: Le rôle du niveau de la charge virale et / ou du nombre de cellules CD4 (Cluster de différenciation 4) dans la aetio-pathogenèse de la perte auditive dans l’infection du VIH est incertain. Par conséquent, nous avons étudié la relation entre le nombre de cellules CD4, la charge virale et le seuil d’audition des adultes infectésdu VIH (virus de l’immunodéficience humain).
Méthodes: Cettecohorted’étude audiométrique a comprisdes adultes infectés par le VIH et non-infectées consécutifs en tant que témoins. Les données cliniques relatives à la perte auditive, le statut VIH et la thérapie antirétrovirale hautement active (HAART) ont été obtenus. L’évaluation audiométrique a été réalisée. Les plus récentsnombre de cellules CD4 et de charge virale ARN des participants infectés par le VIH ont été obtenues à partir des dossiers clinique.
Résultats: Il y avait 299 (66,7%) d’adultes infectés par le VIH et 149 (33,3%) contrôles avec un âge moyen de 39,64+12,45 ans et 39,60+12.45 ans respectivement (p = 0,98). Dans les deux groupes, il y avait plus de participants avec perte auditive de l’oreille gauche. Perte auditiveallant de légère à profonde a été trouvée dans 65,9% des participants infectés par le VIH et 53,7% des contrôles. La majorité (86,3%) des participants infectés par le VIH étaient sous HAART. Le nombre moyen de cellules CD4 était 654,58+289,15 dans 41 participants infectés par le VIH et non sous HAART,et 523,95+300,17 dans 258 participants sous HAART (p = 0,01). La majorité, 197 (62%)participants infectés par le VIH ayant une perte auditive avaient le nombre de cellules CD4 <200 cellule/mm3 . Charge virale plus élevée corrélaitsignificativement avec une faible numération de cellules CD4 (p <0,01; r = 0,18) et faiblenombre de cellules CD4 significativement corrélait avec le seuil d’audition élevé (p <0,01; r = 0,17).
Conclusion: Il y avait une tendance vers une plus grande perte auditive chez les adultes infectés par le VIH. Le seuil d’audition plus élevée chez ceux avec nombrefaible de cellules CD4 <200 cellules/mm3 suggère une possible relation entre l’étatauditive et la gravité de la maladie du VIH.
Mots-clés: Nombre de cellules CD4 +, perte auditive, seuil auditif, VIH, pureaudiométrietonale, charges virales
Correspondence: Dr. Ayotunde J. Fasunla, Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Nigeria. E-mail: ayofasunla@yahoo.com
Erreferentziak
Tuck I, McCain NL and Elswick RK Jr. Spirituality and psychosocial factors in persons living with HIV. J Adv Nurs 2001; 33: 776-783.
Hirabayashi N, Fukunishi I, Kojima K, et al. Psychosocial factors associated with quality of life in Japanese patients with human immunodeficiency virus infection. Psychosomatics 2002; 43: 16-23.
Kovacevic SB, Vurusic T, Duvancic K and Macek M. Quality of life of HIV-infected persons in Croatia. Collegium Antropologium 2006; 30(suppl 2): 79-84.
Aranda-Naranjo B. Quality of life in the HIV-positive patient: implications and consequences. J Assoc Nurses AIDS Care 2004; 15(5 suppl): 20S-27S.
Amodei N, Madrigal A, Catala S, Aranda-Naranjo B and German V. Stress in families of HIV-positive children living in south Texas. Psychol 1997; Rep 81: 1127-1133.
Kushalnagar P, Mckee M, Smith SR, et al. Conceptual model for quality of life among adults with congenital or early deafness. Disabil Health J 2014; 7: 350-355.
Van der Westhuizen Y, Swanepoel de W, Heinze B and Hofmeyr LM. Auditory and otological manifestations in adults with HIV/AIDS. Int J Audiol 2013; 52: 37-43.
Chao CK, Czechowicz JA, Messner AH, et al. High prevalence of Hearing impairment in HIV-infected Peruvian children. Otolaryngol Head Neck Surg 2012; 146: 259-265.
Taipale A, Pelkonen T, Taipale M, et al. Otorhinolaryngological findings and hearing in HIV-positive and HIV-negative children in a developing country. Eur Arch Otorhinolaryngol 2011; 268: 1527-1532.
Palacios GC, Montalvo MS, Fraire MI, et al. Audiologic and vestibular findings in a sample of human immunodeficiency virus type-1-infected Mexican children under highly active antiretroviral therapy. Int J Pediatr Otorhinolaryngol 2008; 72: 1671-1681.
Zahn SB and Kelly LJ. Changing attitudes about the employability of the deaf and hard of hearing. Am Ann Deaf 1995; 140: 381-385.
Foster S and MacLeod J. Deaf people at work: assessment of communication among deaf and hearing peoples in work settings. Int J Audiol 2003; 42 Suppl 1: S128-139.
Blood IM and Blood GW. Effects of acknowledging a hearing loss on social interactions. J Commun Disord 1999; 32: 109-119.
Nglazi MD, West SJ, Dave JA, Levitt NS and Lambert EV. Quality of life in individuals living with HIV/AIDS attending a public sector antiretroviral service in Cape Town, South Africa. BMC Public Health 2014; 14: 676.
Guaraldi G, Prakash M, Moecklinghoff C and Stellbrink HJ. Morbidity in older HIV-infected patients: impact of long-term antiretroviral use. AIDS Rev 2014; 16: 75-89.
Paton NI, Kityo C, Hoppe A, et al. Assessment of second-line antiretroviral regimens for HIV therapy in Africa. N Engl J Med 2014; 371: 234-247.
Khoza-Shangase K. Highly active antiretroviral therapy: Does it Sound toxic? J Pharm Bioallied Sci 2011; 3: 142-153.
Marra CM, Wechkin HA, Longstreth WT, Jr., et al. Hearing loss and antiretroviral therapy in patients infected with HIV-1. Arch Neurol 1997; 54: 407-410.
Akinbami A, Dosunmu A, Adediran A, et al. CD4 Count pattern and demographic distribution of treatment-naïve HIV patients in Lagos, Nigeria. AIDS Res Treat 2012:352753. doi: 10.1155/2012/352753.
Egger M, May M, Chene G, et al. Prognosis of HIV-1 infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002; 360(9327): 119-129.
Hughes MD, Johnson VA, Hirsch MS, et al. Monitoring plasma HIV-1 RNA levels in addition to CD4+ lymphocyte count improves assessment of antiretroviral therapeutic response. Ann Intern Med 1997; 126: 929-938.
Namisango E, Powell RA, Atuhaire L, et al. Is symptom burden associated with treatment status and disease stage among adult HIV outpatients in East Africa? J Palliat Med 2014; 17: 304-312.
Campanini A, Marani M, Mastroianni A, Cancellieri C and Vicini C. Human immunodeficiency virus infection: personal experience in changes in head and neck manifestations due to recent antiretroviral therapies. Acta Otorhinolaryngol Ital 2005; 25: 30-35.
Khoza-Shangase K. HIV/AIDS and auditory function in adults: the need for intensified research in the developing world. Afr J AIDS Res 2010; 9: 1-9.
Pagano MA, Cahn PE, Garau ML, et al. Brainstem auditory evoked potentials in human immunodeficiency virus-seropositive patients with and without acquired immunodeficiency syndrome. Arch Neurol 1992; 49: 166-169.
Khoza K and Ross E. Auditory function in a group of adults infected with HIV/AIDS in Gauteng, South Africa. S Afr J Commun Disord 2002; 49: 17-27.
Khatib N, Zodpey S, Biswas DA, et al. Cross sectional study of audiologic disorders by auditory brainstem evoked response analyzer among people living with HIV in rural areas of wardha district. Int J Biol Med Res 2011; 2: 942-945.
Castro M, Bango Y, Ureta T, Garcia-Lomas V and Lopez G. Hearing loss and human immunodeficiency virus infection. Study of 30 patients. Rev Clin Esp 2000; 5: 271-274.
Alabi BS, Salami AK, Afolabi OA, et al. Otologic and audiological evaluation among HIV patients in Ilorin, Nigeria. Nig Q J Hosp Med 2013; 23: 29-32.
Khosa-Shangase K. An analysis of auditory manifestations in a group of adults with AIDS prior to antiretroviral therapy. Afr J Infect Dis 2011; 5: 11-22.
Hawkins K, Bottone FG Jr, Ozminkowski RJ, et al. The prevalence of hearing impairment and its burden on the quality of life among adults with Medicare Supplement insurance. Qual Life Res 2012; 21: 1135-1147.
Chen JM, Amoodi H and Mittmann N. Cost-utility analysis of bilateral cochlear implantation in adults: a health economic assessment from the perspective of a public funded program. Laryngoscope 2014; 124: 1452-1458.
Salami AK, Fadeyi A, Ogunmodede JA and Desalu OO. Status disclosure among people living with HIV/AIDS in Ilorin, Nigeria. West Afr J Med 2011; 9: 104-112.
Onotai LO, Nwaorgu OG and Okoye BC. Ethical issues in HIV/AIDS infections. Niger J Med 2004; 13: 282-285.
Chow KY, Ang LW, Verghesse I, Chew SK and Leo YS. Measurable predictive factors for progression to AIDS among HIV-infected patients in Singapore. Ann Acad Med Singapore 2005; 34: 84-89.
Bankaitis AE and Keith RW. Audiological changes associated with HIV infection. Ear Nose Throat 1995; 74: 353-359.
Sooy CD. Impact of AIDS on otolaryngology–head and neck surgery. Adv Otolaryngol Head Neck Surg 1987; 1: 1-28.
Cherry CL, Nolan D, James IR, et al. Tissue-specific associations between mitochondrial DNA levels and current treatment status in HIV-infected individuals. J Acquir Immune Defic Syndr 2006; 42: 435-440.
Crain MJ, Chernoff MC, Oleske JM, et al. Possible mitochondrial dysfunction and its association with antiretroviral therapy use in children perinatally infected with HIV. J Infect Dis 2010; 202: 291-301.
Simdon J, Watters D, Bartlett S and Connick E. Ototoxicity associated with use of nucleoside analog reverse transcriptase inhibitors: A report of 3 possible cases and review of the literature. Clin Infect Dis 2001; 32: 1623-1627.
Martinez OP and French MA. Acoustic neuropathy associated with zalcitabine-induced peripheral neuropathy. AIDS 1993; 7: 901–902.
Monte S, Fenwick JD and Monteiro EE. Irreversible ototoxicity associated with zalcitabine. Int J STD AIDS 1997; 8: 201–202.
Powderly WG, Klebert M and, Clifford DB. Ototoxicity associated with dideoxycytidine. Lancet 1990; 1: 1106.
Colebunders R, Dipraetere K, Van Wanzeele P and Van Gehuchten S. Deafness caused by didanosine. Microb Infect Dis 1998; 17: 214–215.
Dalakas MC. Peripheral neuropathy and antiretroviral drugs. J Peripher Nerv Syst 2001; 6: 14-20.
Rey D, L’Heritier A and Lang JM. Severe ototoxicity in a healthcare worker who received postexposure prophylaxis with stavudine, lamivudine, and nevirapine after occupational exposure to HIV. Clin Infect Dis 2002; 34: 417–218.
Makau SM, Ongulo B and, Mugwe P. The pattern of hearing disorders in HIV positive patients on anti-retrovirals at Kenyatta National Hospital. East Afr Med J 2010; 87: 425-429.
Lee KY. Pathophysiology of age-related hearing loss (peripheral and central). Korean J Audiol 2013; 17: 45-49.
Kitcher ED, Ocansey G, Abaidoo B and Atule A. Occupational hearing loss of market mill workers in the city of Accra, Ghana. Noise Health 2014; 16: 183-188.
Hunt PW. HIV and aging: emerging research issues. Curr Opin HIV AIDS 2014; 9: 302-308.