Nakku Doreen, Nyaiteera Victoria, Llowet Evelyn, Nanseera Dennis, Nakalema Gladys, Westerberg Brian, Bajunirwe Francis
Department of Ear, Nose and Throat, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
Department of Ear, Nose and Throat, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
Int J Pediatr Otorhinolaryngol. 2017 Oct;101:172-177. doi: 10.1016/j.ijporl.2017.08.011. Epub 2017 Aug 14.
Pediatric HIV infection and treatment may increase the risk for hearing loss (HL), both sensorineural (SNHL) and conductive hearing loss (CHL). There is limited data on this subject, especially from sub Saharan Africa. The aim of this study was therefore to compare the prevalence of hearing loss among HIV positive and negative children, to determine the types of hearing loss and whether Nevirapine (NVP) based antiretroviral therapy (ART) is associated with HL.
We conducted a cross sectional study at two tertiary health facilities in south western Uganda. We consecutively enrolled 79 HIV negative and 148 HIV positive children aged between 6 and 12 years. Inclusion criteria were completion of written consent, ability to follow instructions to perform an audiogram and absence of congenital HL. We conducted hearing screening using the iPad Shoebox audiometer, and confirmatory assessments were conducted using pure tone audiometry. Hearing was classified as either normal hearing, CHL, SNHL or mixed.
Of the 227 children enrolled, 115 (50.7%) were female. The mean age was 9.2 years (median = 9). Based on self-report, frequency of HL among HIV positive children was 6.8% and 20.3% among HIV negative children (p=<0.01). Using objective measures, prevalence of HL among the HIV positive children was 8.8% compared to 10.1% among the HIV negative children (p = 0.74). CHL was generally more frequent than SNHL but SNHL occurred more frequently among HIV positive (7.4%) compared to HIV negative children (3.8%). No association was found between NVP based ART and HL (p = 0.41). Logistic regression showed that older age of the child (p = 0.01), previous ear infection (p=<0.01), tuberculosis (TB) treatment (p=<0.01) and long term duration on ART (p=<0.01) were significantly associated with HL. Age (p = 0.02), previous ear infection (p = 0.01) and TB treatment (p = 0.005) remained significant in the multiple regression model.
Prevalence of HL is similar among HIV positive and negative children. Older age of the child, previous ear infection, use of TB drugs and long duration on ART among the HIV positive children increase the odds of having hearing loss among children. However, use of NVP was not associated with HL.
儿童艾滋病毒感染及治疗可能会增加听力损失（HL）的风险，包括感音神经性听力损失（SNHL）和传导性听力损失（CHL）。关于这一主题的数据有限，尤其是来自撒哈拉以南非洲地区的数据。因此，本研究的目的是比较艾滋病毒阳性和阴性儿童中听力损失的患病率，确定听力损失的类型，以及基于奈韦拉平（NVP）的抗逆转录病毒疗法（ART）是否与听力损失有关。
我们在乌干达西南部的两家三级医疗机构进行了一项横断面研究。我们连续招募了79名6至12岁的艾滋病毒阴性儿童和148名艾滋病毒阳性儿童。纳入标准为签署书面同意书、能够听从指示进行听力图检查且无先天性听力损失。我们使用iPad Shoebox听力计进行听力筛查，并使用纯音听力测定法进行确诊评估。听力分为正常听力、CHL、SNHL或混合性听力损失。
在纳入的227名儿童中，115名（50.7%）为女性。平均年龄为9.2岁（中位数=9）。根据自我报告，艾滋病毒阳性儿童中听力损失的发生率为6.8%，艾滋病毒阴性儿童中为20.3%（p<0.01）。使用客观测量方法，艾滋病毒阳性儿童中听力损失的患病率为8.8%，艾滋病毒阴性儿童中为10.1%（p = 0.74）。CHL通常比SNHL更常见，但SNHL在艾滋病毒阳性儿童（7.4%）中比在艾滋病毒阴性儿童（3.8%）中更频繁出现。未发现基于NVP的ART与听力损失之间存在关联（p = 0.41）。逻辑回归显示，儿童年龄较大（p = 0.01）、既往耳部感染（p<0.01）、结核病（TB）治疗（p<0.01）以及长期接受ART治疗（p<0.01）与听力损失显著相关。在多元回归模型中，年龄（p = 0.02）、既往耳部感染（p = 0.01）和结核病治疗（p = 0.005）仍然具有显著性。
艾滋病毒阳性和阴性儿童中听力损失的患病率相似。儿童年龄较大、既往耳部感染、使用抗结核药物以及艾滋病毒阳性儿童长期接受ART治疗会增加儿童听力损失的几率。然而，使用NVP与听力损失无关。
