Ensink Robbert J H, Kuper Hannah
Gelre Hospital, Zutphen, The Netherlands.
International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
Trop Med Int Health. 2017 Dec;22(12):1493-1504. doi: 10.1111/tmi.12993. Epub 2017 Nov 20.
To systematically review evidence on the prevalence and characteristics of hearing impairment among children and adults living with HIV in low- and middle-income countries (LMIC).
Articles were identified up to January 2016 through searching four electronic databases. Epidemiological studies conducted in LMIC that explored the association between HIV status and hearing loss, with or without an HIV-uninfected comparison group, were eligible for inclusion. Results were screened and assessed for eligibility, and data were extracted by two reviewers, with discussion in the case of disagreement. Findings were narratively synthesised.
The search identified 638 unique references, of which 21 studies were included in the review, including 3491 people with HIV from 13 LMIC. There was lack of consistency in the definition used for hearing loss, making comparability across studies difficult. Among children with HIV, across the three studies that used a cut-off of >15 dB in either ear, the prevalence of hearing loss ranged from 22 to 37%. Among the three studies that used >25 dB in either ear, the prevalence ranged from 32 to 39%. Among adults with HIV, for the five studies that used a threshold of >25 dB for either ear, the prevalence ranged from 10 to 43%. The prevalence of hearing impairment was significantly higher among people with HIV than in controls in eight of the ten studies that assessed this comparison. Conductive hearing loss was the most common type of hearing loss in children with HIV, while sensorineural hearing loss was more common in adults with HIV. There was a lack of evidence for an association between ART use and hearing loss, although there was some suggestion that late stage of HIV disease or low CD4 count was related to hearing loss. There were concerns about the quality of the studies included in the review.
The current evidence is suggestive of a high prevalence of hearing loss among people living with HIV compared to people without HIV, or to WHO estimates for the general population. More research is needed to better understand the aetiology of hearing loss in relation to HIV, and whether screening for and treatment of hearing loss can be effectively integrated into HIV treatment services needs further research.
系统评价低收入和中等收入国家（LMIC）感染艾滋病毒的儿童和成人听力障碍的患病率及特征的相关证据。
通过检索四个电子数据库，找出截至2016年1月的文章。在LMIC进行的探索艾滋病毒感染状况与听力损失之间关联的流行病学研究，无论是否有未感染艾滋病毒的对照组，均符合纳入标准。对结果进行筛选和资格评估，由两名评审员提取数据，如有分歧则进行讨论。研究结果进行叙述性综合分析。
检索到638篇独特参考文献，其中21项研究纳入综述，包括来自13个LMIC的3491名艾滋病毒感染者。听力损失的定义缺乏一致性，使得各研究之间难以进行比较。在感染艾滋病毒的儿童中，在三项采用任一耳听力阈值>15dB标准的研究中，听力损失患病率在22%至37%之间。在三项采用任一耳听力阈值>25dB标准的研究中，患病率在32%至39%之间。在感染艾滋病毒的成人中，在五项采用任一耳听力阈值>25dB标准的研究中，患病率在10%至43%之间。在评估该对比的十项研究中，有八项研究显示艾滋病毒感染者的听力障碍患病率显著高于对照组。传导性听力损失是感染艾滋病毒儿童中最常见的听力损失类型，而感音神经性听力损失在感染艾滋病毒的成人中更为常见。虽然有一些迹象表明艾滋病毒疾病晚期或低CD4细胞计数与听力损失有关，但缺乏抗逆转录病毒治疗（ART）使用与听力损失之间关联的证据。对纳入综述的研究质量存在担忧。
目前的证据表明，与未感染艾滋病毒的人或世界卫生组织对一般人群的估计相比，艾滋病毒感染者中听力损失的患病率较高。需要更多研究来更好地了解与艾滋病毒相关的听力损失病因以及听力损失的筛查和治疗能否有效纳入艾滋病毒治疗服务，这需要进一步研究。
