ABR and rate study in normal hearing adults with HIV

Abstract

The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) have become more prevalent throughout the world. The widespread availability of antiretrovirals (ARV’s) has now shifted the mindset from mortality to morbidity. Hearing health care professionals now have a wide client base consisting of adults with HIV who have a diminished quality of life due to hearing loss accompanying the virus. The auditory brainstem response (ABR) can be useful in research studies regarding HIV/AIDS as the virus has an affinity to the host’s nervous system. The current study aimed to investigate the clinical usefulness of the ABR and ABR rate study in adults with HIV who presented with normal hearing sensitivity. Forty participants enrolled in the current study (27 female). All participants were using first-line ARV’s consisting of Tenofovir, Emtricitabine and Efavirenz. A total of 80 ears were analysed in the data analysis process. The mean age of the participants was 26.30 standard deviation (SD 3.68) range 19 to 31. The mean CD4+ count was 559.40 cells/μL (SD 220.250) range 208 to 1200. The mean duration on ARV’s was 6.68 years (SD 5.098) range 1 to 25. The Shapiro-Wilk test for normality of distribution was statistically significant (p<0.05) indicating that the data was not normally distributed. The non-parametric Friedman’s test of analysis of variance was used to determine whether there was a statistically significant difference between the latencies of wave V at the different stimulus repetition rates. The diagnostic performance of the rate study was further evaluated using receiver operating characteristic (ROC) curve analysis. Accuracy was measured by the area under the ROC curve (AUC). No difference between the median absolute latencies and interwave latencies were found within this study sample when compared to recognised normative data. The current study showed a high statistically significant difference (p<0.001), between Wave V at the three stimulus repetition rates although the median was still within the norm. The current study also showed that the diagnostic accuracy of the ABR and the ABR rate study increased with a decrease in CD4+ counts. Therefore, the current study advocates for the inclusion of the ABR and the ABR rate study in the HIV positive population for early identification of subtle neural disorders. A time-efficient protocol consisting of a neurological ABR at 27.7 Hz followed by a rate study at 61.1 Hz may be recommended.