Is hearing impairment associated with HIV? A systematic review of data from low- and middle-income countries.

OBJECTIVES: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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

Undiagnosed HIV infection among adolescents seeking primary health care in Zimbabwe.

BACKGROUND: Mother-to-child transmission of human immunodeficiency virus (HIV) infection was extremely common in southern Africa during the 1990s, and a substantial minority of infected infants have survived to reach adolescence undiagnosed. Studies have shown a high prevalence of HIV infection in hospitalized adolescents who have features associated with long-standing HIV infection, including stunting and frequent minor illnesses. We therefore investigated the epidemiology of HIV infection at the primary care level. METHODS: Adolescents (aged 10-18 years) attending two primary care clinics underwent HIV and Herpes simplex virus-2 (HSV-2) serological testing, clinical examination, and anthropometry. All were offered routine HIV counseling and testing. Patients attending for acute primary care (APC) who were HIV infected were asked about their risk factors. RESULTS: Five hundred ninety-four participants were systematically recruited (97% participation), of whom 88 (15%) were attending for antenatal care. HIV infection prevalence was higher among APC attendees than among antenatal care attendees (17% vs 6%; P < .007), but for the prevalence of HSV-2 infection, a marker of sexually acquired HIV, the converse was true (4% vs 14%; P < .002). Seventy (81%) of 86 HIV-positive APC attendees were previously undiagnosed. They had a broad range of presenting complaints, with a median CD4 cell count of 329 cells/microL (interquartile range, 176-485 cells/microL) and a high prevalence of stunting, compared with the corresponding prevalence among HIV-negative attendees (40% vs 12%; P < .001). Maternal transmission was considered to be likely by 69 (80%) of the 86 HIV-positive APC attendees, only one of whom was HSV-2 positive. CONCLUSIONS: Unrecognized HIV infection was a common cause of primary care attendance. Routine HIV counseling and testing implemented at the primary care level may provide a simple and effective way of identifying older long-term survivors of mother-to-child transmission before the onset of severe immunosuppression and irreversible complications

Hearing impairment and deafness among HIV infected children and adolescents in Harare, Zimbabwe.

Background: Among HIV-infected children ear infections are recurrent and chronic, which may lead to hearing loss. Objective: To determine the prevalence, cause and severity of hearing impairment among HIV-infected children aged 5-17 years attending for HIV care in Harare. Design and Setting: An analytical cross-sectional survey conducted at Newlands Clinic, an opportunistic infections clinic in Harare. Materials and Methods: Participants underwent a standardised otoscopic examination of the ear and Pure Tone Audiometry (PTA). Factors associated with hearing impairment were investigated using multivariate logistic regression. Results: Three hundred and eighty (380) participants (55% female and mean age 11 years (SD: 3.3 years)) were consecutively recruited. The vast majority of participants (n=338; 89% were taking antiretroviral therapy (ART) for a median of 3 (IQR: 2-5) years at recruitment, and the most recent median CD4 Count (i.e. CD4 count measured within 6 months of the study recruitment) was 725 (IQR: 497-1000) cells/µL, with no difference by ART status. 61% (n= 231) of participants had an abnormal ear examination. Of the 359 participants who underwent audiometry, the prevalence of hearing impairment was 32.3% (95%CI: 27.5%-37.4%) based on a PTA threshold ≥26Db. Hearing impairment was associated with a recent CD4 count <350cell/µL (OR 2.1, P<0.037). Conclusion: There is a high prevalence of hearing impairment among HIV-infected children and adolescents. Low CD4 count remains a risk factor even among those who are on ART. We recommend that HIV infected children and adolescents, particularly those with low CD4 counts, should have routine evaluation of hearing as part of HIV care