Audiological profile of people living with HIV/ AIDS

In honour of World AIDS Day, 1st of December

The first Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (HIV/AIDS) outbreak was in the early 1980s, today there are approximately 38 million people living with HIV/AIDS across the globe. The spectrum of HIV/AIDS complications is broad — the condition affects critical human organs including sensory organs. 

World AIDS Day was first observed on December 1st, 1988 to raise awareness and demonstrate international solidarity against this pandemic. 32 years later, the theme for 2020 is “Ending the HIV/AIDS Epidemic: Resilience and Impact”. For World AIDS Day, we hope our article will contribute knowledge regarding the support of people living with HIV/AIDS who have manifestations of audiological and otological complications. Remembering that support is not limited to emotional and psychological support, but also physical (including clinical), and social support. If more awareness is brought forward about these aspects which HIV/AIDS patients are dealing with, then hopefully we have played our part on this day.

World AIDS Day is an occasion for people around the world to join in the fight against HIV, to show support for people living with HIV and to honour those who have lost their lives to AIDS-related illnesses.

Audiological profile of people living with HIV/ AIDS

The audiological profile of people living with HIV/AIDS can be divided into two parts. i) those who are on HIV/AIDS treatment and ii) those who are not on HIV/AIDS treatment. Studies have shown that both groups exhibit higher hearing thresholds (when confounders have been controlled) than individuals without HIV/AIDS. This is an indicator that the virus has a direct effect on the auditory system, and the treatment used has an independent effect as well.

Other otologic symptoms and manifestation in people living with HIV/ AIDS include tinnitus, vertigo, otitis media/ externa, otalgia, and hearing loss.

Direct effects of HIV/ AIDS

The exact pathophysiology on the contribution of HIV/AIDS on the destruction of the Central Nervous System (CNS) involving the auditory pathway is not clear. The Central Auditory Pathway can be evaluated using electrophysiological tools such as the brainstem evoked responses (ABR), electrocochleography (EcoG), middle, and late latency evoked responses (MLR, LLR), and other specific tests. When comparing ABR latencies in HIV positive and negative individuals, studies show prolonged ABR latencies in HIV positive individuals. This phenomenon has been shown with MLR tests as well — showing prolonged latencies and decreased amplitudes in HIV positive individuals when compared to HIV negative individuals. Contrary to this above evidence, some studies suggest that HIV positive people who have subjective hearing complaints do not exhibit any abnormalities when assessed with objective audiometry. Thus, ABR measurements are not always affected in HIV positive individuals. This makes the mechanism of the destruction of the Central Auditory Pathway as a result of HIV/AIDS unclear.

Immunocompromisation, opportunistic infections, and auditory conditions

Opportunistic infections are illnesses that occur more frequently in patients who are immunocompromised (i.e. living with HIV/AIDS). These illnesses tend to be more severe in HIV/AIDS individuals than individuals who are HIV negative. Some of the well known opportunistic infections in HIV/AIDS individuals include pneumonia and tuberculosis. Specific to otology, studies have found that HIV positive individuals are more susceptible to otitis media (middle ear infections) as compared to individuals who are HIV negative. In addition to this, HIV positive children are more susceptible to otitis media than HIV positive adults — this is because of their immature immune system, making them more at risk. Otitis media, in both adults and children, can lead to a conductive hearing loss that impacts one’s hearing ability affecting their communication. 

Many opportunistic infections are treated using medications that are known to be ototoxic. Therefore, the audiological profile of people living with HIV/AIDS may be influenced by the treatment they are using for opportunistic infections. Aminoglycosides, used to treat Multidrug-resistant TB (MDR-TB), is perhaps one of the most documented medications with ototoxic effects. As noted above, both pneumonia and TB are opportunistic infections in HIV/AIDS individuals, although both infections do not affect the auditory system directly, their treatment (e.g. the use of azithromycin for pneumonia) have been shown to have a damaging effect on the cochlear hair cells. These treatments may lead to permanent hearing loss.

HIV/ AIDS treatment and auditory function

The use of Highly Active Antiretroviral Therapy (HAART) in people with HIV/AIDS have been shown to be associated with auditory effects. In one study, audiological results were compared in individuals on HAART and those who are HIV negative (and not using HAART). Clinically significant changes were observed in individuals using HAART when assessed using pure tone audiometry. In addition, distortion product otoacoustic emissions (DPOAEs) test showed clinically significant changes in the higher frequencies of the same experimental group. This implies that there are subclinical hearing function changes associated with the use of HAART.

Audiological support of people living with HIV/ AIDS

The audiological profile of people living with HIV/AIDS is independently affected by the virus itself, medication used for treatment of the virus, opportunistic infections, and medication used for the treatment of opportunistic infections. The above findings highlight the paramount importance of closer monitoring of auditory/ and otologic functionality in people living with HIV/AIDS.

In order to achieve the 90-90-90 treatment target, a holistic support of those living with HIV/AIDS cannot be overstated. In order to have 90% of HIV/AIDS people on treatment, side effects that come with both the condition/s and treatment/s must be monitored and addressed. It is a known fact that one of the factors that contribute to people stopping their treatment is adverse side effects such as loss of hearing. It is important that healthcare practitioners are aware of the wide complications of HIV/AIDS and support patients in managing them.

The 90-90-90 strategy is quite ambitious. But if we fight the virus together and support those living with it — in any meaning, then the strategy is achievable.