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Possible link between HIV and vestibular impairment in men and women
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22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018
from Jules: some older aging HIV+ experience balance & walking or neurologic imbalances, and frailty which also can be associated with walking impairments, and cognitive impairment can contribute as well. So can neuropathy. It's possible that for some with these problems that Vestibular Impairment may contribute to these problems, but perhaps also mitochondrial damage and sarcopenia (muscle weakness).
balance disorder.......https://en.wikipedia.org/wiki/Balance_disorder
https://vestibular.org/understanding-vestibular-disorder/symptoms....The vestibular system includes the parts of the inner ear and brain that help control balance and eye movements. If the system is damaged by disease, aging, or injury, vestibular disorders can result, and are often associated with one or more of these symptoms, among others: Vertigo and dizziness, hearing changes.
Treatment - Treatment for vertigo, imbalance, and dizziness due to vestibular dysfunction.....https://vestibular.org/understanding-vestibular-disorder/treatment
Mark Mascolini
HIV infection more than doubled the odds of vestibular function impairment (VFI) in a comparison of people with versus without HIV infection in the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS), but the association fell just short of statistical significance [1]. Men had significantly lower odds of VFI than women.
The vestibular system in the ear contributes to balance by providing information about motion, equilibrium, and spatial orientation [2]. A systematic review of 13 studies exploring vestibular function in people with HIV proposed that central vestibular impairment occurs even at asymptomatic stages of HIV infection and becomes more prevalent with advanced stages of infection [3]. But all these studies had limitations, including small sample sizes and varying antiretroviral use.
To learn more about VFI in people with HIV, researchers at Georgetown University and other centers analyzed data from HIV-positive and negative men in the Baltimore/Washington, DC MACS group and HIV-positive and negative women in the Washington, DC WIHS group. All participants had vestibular evoked myogenic potential (VEMP) testing and electronystagmography (ENG) including bi-thermic caloric (BCT) stimulation testing. To identify predictors of VFI, the researchers used proportional odds regression models on data from combined HIV-positive and negative participants and from the HIV groups alone, adjusting for HIV status, sex, age, undetectable viral load, and ever using antiretroviral monotherapy or combination antiretroviral therapy (ART).
The analysis included 80 men and 84 women with HIV, and 58 men and 18 women without HIV. For those 4 groups, median ages were 54.3, 49.1, 68, and 44.2 Respective proportions of blacks were 56%, 82%, 17%, and 72%. Among people with HIV, 92% had ever used combination ART, 80% had an undetectable viral load, and median CD4 count stood at 575.
Regression analysis involving the entire study group linked HIV infection to doubled odds of any VFI (adjusted odds ratio [aOR] 2.30), but that association stopped short of statistical significance (95% confidence interval [CI] 0.90 to 5.87, P = 0.080). VFI odds with HIV were greater for central impairment (aOR 4.57, 95% CI 0.57 to 36.92, P = 0.154) than for peripheral impairment (aOR 1.50, 95% CI 0.37 to 2.27, P = 0.421). Compared with women, men had significantly lower odds of central VFI (aOR 0.05, 95% CI 0.01 to 0.38, P = 0.004) and any VFI (aOR 0.37, 95% CI 0.17 to 0.79, P = 0.009). Age did not predict VFI.
In the analysis limited to men and women with HIV, current ART and viral suppression lowered odds of VFI but not significantly. Neither age nor use of antiretroviral monotherapy independently affected odds of VFI. Men with HIV had significantly lower odds of any VFI than women with HIV (aOR 0.36, 95% CI 0.15 to 0.87, P = 0.022) and lower odds of central VFI (aOR 0.04, 95% CI 0.00 to 0.34).
The researchers called for longitudinal studies to see whether vestibular function worsens more over time with HIV than without HIV, which could make balance disorders and resulting falls more likely in older people.
References
1. Plankey M, Pichert M, Springer G, Cox C, Cohen H. Vestibular function among Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS) participants. AIDS 2018: 22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018. Abstract TUPEB138.
2. Vestibular.org. The human balance system. https://vestibular.org/understanding-vestibular-disorder/human-balance-system#
3. Heinze B, Swanepoel DW, Hofmeyr LM. Systematic review of vestibular disorders related to human immunodeficiency virus and acquired immunodeficiency syndrome. J Laryngol Otol. 2011;125:881-890.
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