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Hearing Loss and HIV....MACS & WIHS
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3 studies report Hearing Loss in HIV is Worse and Suggests that Aging Worsens Hearing - (09/01/17)
A new study finds that HIV-positive adults are more likely to experience hearing loss, regardless of disease severity or treatment.
http://newscenter.sdsu.edu/sdsu_newscenter/news_story.aspx?sid=75372
"The researchers aren't able to explain the physiological mechanism behind hearing loss in HIV-positive people, but the fact that it occurs regardless of the use of HIV medication or other disease variables suggests that it could be a response to inflammation or some other process caused by the HIV virus itself, Torre explained. Study co-author Howard Hoffman, director of epidemiology/statistics at NIDCD, noted that the pattern of hearing loss across both low and high frequencies for these middle-aged HIV positive subjects is reminiscent of that found for adults with diabetes."
Compared to adults without HIV, HIV-positive adults are at higher risk for hearing loss independent of their severity of infection or adherence to medications, according to a new study published today in the journal JAMA Otolaryngology-Head & Neck Surgery. It is the first comprehensive study to examine hearing loss after accounting for the effect of HIV medication use, adherence and HIV related-disease factors.
Researchers have known since the early 1980s that there appears to be an association between HIV and hearing loss, but it has proven difficult to explain exactly how and why it occurs.
Peter Torre, a hearing scientist who specializes in epidemiology at San Diego State University, conducted the study with colleagues from Georgetown University, Johns Hopkins University and the National Institute on Deafness and Other Communication Disorders (NIDCD). The National Institutes of Health funded the study.
The researchers recruited middle-aged HIV-infected participants from two long-standing HIV cohort studies: men from the Multicenter AIDS Cohort Study, which began in 1984, and women from the Women's Interagency HIV Study, which began in 1994. The recent study was overseen by Michael Plankey, an infectious disease epidemiologist and investigator for both cohort studies.
Torre, the study's lead author, designed an experimental procedure to screen these participants for various symptoms of hearing loss. After being screened out for various prior symptoms of hearing loss, each participant had a standard clinical hearing test at a university-based audiology clinic to determine whether they could hear a variety of tones ranging from 250 to 8000 hertz at different volume thresholds. The researchers also collected data on how long the HIV-positive participants' had been taking HIV medication and how adherent they were to the treatment regimens. They also measured participants' white blood cell count and the amount of HIV virus in the blood to determine disease progression.
Existing literature predicted that researchers would find results similar to premature aging in the HIV-positive participants. That is, they expected those participants' low-frequency hearing to be relatively intact with a drop-off toward higher frequencies.
"What we found was a little different from what we expected," Torre said.
They found that the HIV-positive men and women had trouble hearing both the low tones and the high tones. On average, their threshold for hearing the tones was about 10 decibels higher than HIV-negative men and women.
The participants' white blood cell count, amount of HIV virus in the blood, duration of time taking HIV medications and adherence did not explain the hearing loss found among the HIV-positive men and women.
The researchers aren't able to explain the physiological mechanism behind hearing loss in HIV-positive people, but the fact that it occurs regardless of the use of HIV medication or other disease variables suggests that it could be a response to inflammation or some other process caused by the HIV virus itself, Torre explained. Study co-author Howard Hoffman, director of epidemiology/statistics at NIDCD, noted that the pattern of hearing loss across both low and high frequencies for these middle-aged HIV positive subjects is reminiscent of that found for adults with diabetes.
This group of investigators will be conducting additional studies to uncover the reasons for this hearing loss.
"Our hope is that by understanding exactly how HIV relates to hearing loss, we can find or develop some medication that is therapeutic or protective against loss of hearing," Torre said.
This research was supported by the National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), via interagency agreement with the National Institute of Allergy and Infectious Diseases (NIAID), NIH, for Cooperative Agreements U01 AI-035042-18 and U01 AI-034994-17.
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Hearing Loss Among HIV-Seropositive and HIV-Seronegative Men and Women
Peter Torre III, PhD; Howard J. Hoffman, MA; Gayle Springer, MLA; Christopher Cox, PhD; Mary A. Young, MD;
Joseph B. Margolick, MD, PhD; Michael Plankey, PhD
ABSTRACT
JAMA Otolaryngol Head Neck Surg. 2015;141(3):202-210. doi:10.1001/jamaoto.2014.3302
Abstract
Importance Age-related hearing loss affects quality of life. Data on hearing loss among aging human immunodeficiency virus–seropositive (HIV+) adults are limited.
Objective To evaluate pure-tone hearing thresholds among HIV+ and HIV-seronegative (HIV-) adults and to determine whether HIV disease variables and antiretroviral therapy are associated with pure-tone threshold levels.
Design, Setting, and Participants A total of 262 men (117 HIV+) from the Baltimore, Maryland/Washington, DC, site of the Multicenter AIDS Cohort Study and 134 women (105 HIV+) from the Washington, DC, site of the Women's Interagency HIV Study participated. Pure-tone air conduction thresholds were collected in a sound-treated room for each ear at frequencies from 250 through 8000 Hz. Linear mixed regression models tested the effect of HIV on hearing after adjustment for age, sex, race, and noise exposure history.
Main Outcomes and Measures Low-frequency pure-tone average (LPTA) at 250, 500, 1000, and 2000 Hz and high-frequency PTA (HPTA) at 3000, 4000, 6000, and 8000 Hz. Differential HIV effects for LPTA and HPTA and better/worse ear were also examined. CD4+ and CD8+ T-cell counts, log10 plasma HIV RNA concentrations, receipt of AIDS diagnosis, and cumulative duration of antiretroviral therapy were included in the models for HIV+ participants only.
Results HPTA and LPTA were significantly higher (18%: estimated ratio, 1.18 [95% CI, 1.02-1.36]; P = .02; and 12%: estimated ratio, 1.12 [95% CI, 1.00-1.26]; P = .05, respectively) for HIV+ participants compared with HIV- participants for the better ear. The direction of the effect was consistent across both the better and worse ears. There were no significant associations between HIV disease variables or treatment variables and LPTA or HPTA.
Conclusions and Relevance The HIV+ adults had significantly poorer lower-frequency and higher-frequency hearing than HIV- adults. High-frequency hearing loss is consistent with an accelerated aging (presbycusis); low-frequency hearing loss in middle age is unexpected. Because some vowels and consonants have predominantly low-frequency acoustic energy, poor low-frequency hearing may impair communication in HIV+ individuals.
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