A.J. Fasunla1,2, S.A. Ogunkeyede1,2, and S.O. Afolabi3
- Department of Otorhinolaryngology, College of Medicine, University of Ibadan
- Department of Otorhinolaryngology, University College Hospital, Ibadan
- BSA Speech and Hearing Consult, Lagos
Background: Human immunodeficiency virus-infected adolescents have insufficient CD4 T cell count, and despite attaining viral suppression with HAART regimen, some experience significant hearing loss.
Objective: To determine the association between the hearing thresholds in HIV positive adolescent on highly active antiretroviral therapy and CD4 T cell count.
Method: In this cross-sectional study, 63 adolescents receiving highly active antiretroviral therapy had pure tone audiometry and hearing thresholds determined using standard method. Additional data collected using proforma include biodata type of HAART regimens, treatment duration, the nadir and current CD4- cell count (cells/ml) and viral load (copies/ml) levels. These clinical parameters were correlated with hearing thresholds. Statistical analysis done included univariate analysis and multivariate logistic regression using Statistical Product and Service Solutions (SPSS version 20) and level of statistical significance was determined at P < 0.05.
Results: There were 63 participants comprising of 26 (41.3%) males and 37 (58.7%) females, age ranged from 13 – 17 years (mean age 14.7years ± 1.65). Hearing loss was found in 20.6% adolescents and was predominantly sensorineural hearing loss. There was association between hearing threshold, nadir CD4 count and viral load, but not with gender, current CD4 count and viral load, HAART regimen, and treatment duration.
Conclusion: The high prevalence of adolescents with hearing impairment showed that there might be an association with the disease and/its treatment hence the need for inclusion of periodic hearing evaluation in the routine clincal care of HIV-infected adolescent on HAART.
Key words: Adolescents, CD4 nadir, HIV, Sensorineural hearing loss, Nigeria
Dr. S.A. Ogunkeyede
Dept. of Otorhinolaryngology,
University College Hospital,
The burden of human Immunodeficiency Virus (HIV) infection in Nigeria is the second highest world-wide with a challenge to the public health.1 The prevalence of the disease is high among adolescents in sub-Saharan African countries.2,3 In them, the disease might have been contacted from birth, or via unprotected sexual intercourse, use of contaminated blood products and practice of sharing sharp objects.4,5,6,7
HIV-infection is a risk factor for hearing loss and the magnitude seems to increase with the severity of the disease.8 This may be conductive or sensorineural. The sensorineural hearing loss in HIV patients may be due to direct neurotropic effect of HIV on either the central nervous system or peripheral auditory nerve (neurotoxicity).9,10,11 Sudden sensorineural hearing loss and demyelination in the brain stem with significant increase in latencies on auditory brain stem has been reported 12, 13 and this may be due to the direct action of the virus on central nervous system. Other causes of hearing loss in HIV infected adolescent may include chronic suppurative otitis media, ototoxicity from antiretroviral therapy and aminoglycosides used in the treatment of tuberculosis which is a common opportunistic infection that is associated with HIV. 8,14,15
Meningitis and encephalitis may occur as an opportunistic infection in HIV patients because of poor humoral and cell-mediated immunity, with a significant consequence on hearing threshold.16 The defective chemotaxis and phagocytosis may cause increased vulnerability to middle ear infection17. The persistent generalized lymphadenopathy could block the Eustachian tube opening leading to serous otitis media and conductive hearing loss.
The value of CD4 cell count measures the degree of immunosuppression in HIV-positive patients. Highly active antiretroviral therapy (HAART) often leads to substantial reduction in viral load and immune recovery in HIV-infected individual.18 CD4 T-cell status is a strong prognostic indicator of mortality and disease progression among individuals living with HIV.19 Some antiretroviral medications may be ototoxic20, thus it has been difficult to make conclusions regarding the cause of changes in hearing function in HIV-infected patients on the medication.
Accelerated aging has been suggested as a potential explanation for the disproportionate increase in complications of age related problems including hearing loss even in individuals living with HIV/AIDS. Improved medical, nutritional, psychosocial and pharmacological care have converted HIV infection from a terminal to a chronic health condition with increased life expectancy8, thus making them to need long-term hearing care.
Information is sparse on hearing status of HIV infected adolescents in Nigeria, hence this study was conducted to determine hearing threshold and the association between it and viral load, CD4 cell counts and HAART administration.