Associação entre HIV e alterações auditivas em crianças

Abstract

The association between HIV/AIDS and hearing loss among children has inconsistent data in the literature, especially those regarding the most frequent type of hearing loss and the influence of viral load and CD4 lymphocyte counts. There is a lack of national protocols regarding the audiological follow up of children living with HIV/AIDS, like those for children with HIV and co-infection with syphilis and toxoplasmosis. To improve the knowledge about the influence of HIV on the hearing of children and encourage measures for prevention, early diagnosis and rehabilitation, we proposed to study the association between HIV and hearing loss, with greater methodological detailing and minimized confounding factors. This study was conducted in two referral institutions (Hospital Universitário da Universidade Federal do Maranhão e Centro de Saúde de Fátima). The study group was composed by 18-months to 12-years-old children diagnosed with HIV infection. The comparison group was children not living with HIV. After otoscopy, patients have been referred to perform otoacoustic emissions exam and tympanometry. If they fail, or the otoscopy is abnormal, or parents have complaints, a second exam (pure-tone audiometry and auditory brainstem response) was performed. The STATA 12.0 program was used to carry on the statistical analysis of the data. Forty-two children living with HIV and 41 controls were evaluated. Most of the children (59.5%) were born from mothers without the diagnosis of HIV infection until delivery. There was significant difference in the incidence of complaints (p= 0.005), abnormal otoscopy (p= 0.026), fail in otoacoustic emissions (p= 0.006) and abnoral tympanometry (p= 0.000). The only type of hearing loss found was conductive. Viral load, CD4 lymphocyte count, antiretroviral therapy and time of treatment were not correlated to fail in otoacoustic emissions. HIV infection was shown as risk fator for hearing loss (OR= 7.02; p= 0.011). Hearing loss related to middle ear impariment among children with HIV is described in literature. Failures in prenatal care and infection through breastfeeding lead to late diagnosis of HIV infection and no audiological follow up until the third year of life as recommended by the Comitê Multiprofissional em Saúde Auditiva. The lack of cure for infection by this virus requires long exposure to direct and indirect effects of HIV these children to old age, with progressive accumulation of auditory damage. Extended test protocols for the prevention of mother-to-child infection regardless the suspicion of maternal infection is proposed. Also, annual auditory screening of children with HIV through adolescence is suggested. Health professionals and managers should pay attention to the problem of vertical transmission of HIV and audiological evaluation of these children, preventing impacts on their development.