Hearing Impairment in Children Living with HIV in Haiti

Abstract

Objective To identify the prevalence of hearing impairment and associated risk factors in children living with human immunodeficiency virus (HIV) in Haiti. Methods A validated smartphone-based platform with pure-tone audiometry was used to screen 341 HIV-infected children for hearing impairment in Port-au-Prince, Haiti from March 2019 to September 2020. If screening was failed, a more comprehensive pure-tone audiometric evaluation was administered. Demographic, otologic, and HIV-related data were obtained through caregiver surveys and medical charts. Statistical analysis included univariate and multivariate logistic regression. Results Sixty (18%) of 341 HIV-infected children (ages 7–18 years) had hearing impairment. Of those failing their hearing assessment, 17 (28%) had moderate and 5 (8%) had severe or profound hearing loss. Hearing impairment was associated with frequent ear infections (OR 3.37; 95% CI 1.76–6.46; p < 0.001) and family history of hearing loss (OR 5.12; 95% CI 2.14–12.23; p = 0.001) but not viral load (OR 1.00; 95% CI 0.73–1.02; p = 0.28) or antiretroviral therapy duration (OR 0.96; 95% CI 0.79–1.17; p = 0.66). Only 35% of caregivers correctly perceived their child's hearing loss. Conclusions Hearing impairment occurs at a higher prevalence in HIV-infected children in Haiti than what is expected for those living without HIV. Frequent ear infections were significantly associated with hearing loss while antiretroviral therapy duration was not. Despite their potential ototoxicity, antiretroviral therapies should be continued and may decrease incidence of otitis media. Low caregiver perception of hearing loss emphasizes the need for routine hearing screening for HIV-infected children.