Otoneurological findings in human immunodeficiency virus positive patients

Abstract

Objective: To investigate vestibular function in human immunodeficiency virus positive subjects.Methods: We studied vestibular function in 60 human immunodeficiency virus positive subjects reporting dizziness. All three Center for Disease Control and Prevention categories of human immunodeficiency virus infection were represented in the study group (30 patients in class A, 20 in class B and 10 in class C). Subjects had had no previous history of acute vertigo. All subjects underwent: neurotological screening for spontaneous, positional and positioning nystagmus, using head-shaking and head-thrust (Halmagyi) tests; audiometrical examination; and electronystagmography with bithermal stimulation (Freyss' method). The results of the 30 class A subjects were compared with those of 30 human immunodeficiency virus negative patients reporting dizziness.Results: Abnormal otoneurological findings increased progressively from the A to C categories, particularly regarding increased central damage (3.3 per cent of class A, 35 per cent of class B and 100 per cent of class C subjects). In contrast, the incidence of peripheral vestibular disorders remained almost the same, comparing the three categories (33.3 per cent in class A and 50 per cent in classes B and C subjects). Moreover, a higher number of human immunodeficiency virus positive subjects showed abnormal otoneurological findings, compared with the dizzy, human immunodeficiency virus negative subjects.Conclusions: In our opinion, a vestibular disorder may occur in human immunodeficiency virus positive patients as a result of direct viral damage, even in the early phase of infection. Central vestibular damage may be established later on, and may be linked to different causes (e.g. superinfections, vascular causes and drug toxicity).

Systematic review of vestibular disorders related to human immunodeficiency virus and acquired immunodeficiency syndrome

“…30,33,37,40 Seven group studies were identified, of which two were descriptive 29,31 and five were quasi-experimental in nature. 18,32,34,35,39 These group studies aimed to investigate the nature of vestibular disorders and types of vestibular manifestations associated with HIV/AIDS. All patients were adults, except for one study investigating HIV/AIDS-related vestibular function in children aged 16 years and below.…”

“…17 In addition to the auditory manifestations of HIV/ AIDS, vestibular dysfunction has also been documented. 18 The cochlea and vestibular organ, situated in the temporal bone, are interconnected and constitute the membranous labyrinth; they also share the same fluids, namely endolymph and perilymph. Their nerve fibres together constitute the VIIIth cranial (cochleovestibular) nerve.…”

Does the human immunodeficiency virus influence the vestibulocollic reflex pathways? A comparative study

“…Three of the four studies indicate similar abnormal caloric test findings in subjects with HIV compared to the current study (26.5%; n=9). The two most recent studies 22,23 found abnormal caloric test results in 43.3% and 50% respectively in their sample of subjects with HIV. Their samples of subjects were all symptomatic, since they suffered from chronic dizziness.…”

“…20 The caloric findings in the current study could be compared with those of four previous research reports that employed a group study design of adult subjects with HIV. [22][23][24][25] The abnormal caloric test findings demonstrated the presence of abnormal functioning of the VOR pathway. Three of the four studies indicate similar abnormal caloric test findings in subjects with HIV compared to the current study (26.5%; n=9).…”

“…Three previous studies, that also used a cross-sectional research design, demonstrated an increase in vestibular involvement from early to advanced stages of the disease. 22,23,25 A detailed summary of their findings has been reviewed elsewhere. 13 There is a higher occurrence of abnormal cVEMP and caloric test findings in the advanced stages of HIV, due to the reduction in CD4+ cell counts that places the infected individual at-risk for various opportunistic infections.…”