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

Abstract

Introduction: Disorders of the auditory and vestibular system are often associated with human immunodeficiency virus infection and acquired immunodeficiency syndrome. However, the extent and nature of these vestibular manifestations are unclear.Objective: To systematically review the current peer-reviewed literature on vestibular manifestations and pathology related to human immunodeficiency virus and acquired immunodeficiency syndrome.Method: Systematic review of peer-reviewed articles related to vestibular findings in individuals with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Several electronic databases were searched.Results: We identified 442 records, reduced to 210 after excluding duplicates and reviews. These were reviewed for relevance to the scope of the study.Discussion: We identified only 13 reports investigating vestibular functioning and pathology in individuals affected by human immunodeficiency virus and acquired immunodeficiency syndrome. This condition can affect both the peripheral and central vestibular system, irrespective of age and viral disease stage. Peripheral vestibular involvement may affect up to 50 per cent of patients, and central vestibular involvement may be even more prevalent. Post-mortem studies suggest direct involvement of the entire vestibular system, while opportunistic infections such as oto-and neurosyphilis and encephalitis cause secondary vestibular dysfunction resulting in vertigo, dizziness and imbalance.Conclusion: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome should routinely be monitored for vestibular involvement, to minimise functional limitations of quality of life.

Vestibular involvement in adults with HIV/AIDS

“…The reduction in morbidity and mortality is changing HIV/AIDS from a life-threatening disease to a chronic illness with an increasing emphasis on quality of life issues [2].…”

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

“…Such small differences would not be considered clinically significant Possible mechanisms for the increased VCR and VOR abnormalities may include opportunistic infections, ototoxic treatments and direct effects of HIV. 13 Opportunistic infections may partly affect the functioning and integrity of both branches of the vestibular nerve (and the structures that they innervate). Young 27 reported five patients with the herpes zoster virus, a common HIVrelated opportunistic infection, suffering from vertigo.…”

“…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. This necessitates the use of ARV therapies to strengthen immunity in order to combat opportunistic infections; however, the vestibular nerves and structures of the vestibular end-organs may be susceptible to ototoxicity and also to the infections themselves, resulting in abnormal cVEMP and caloric test results.…”

“…A recent systematic literature review summarized all vestibular tests and findings in subjects with HIV/AIDS demonstrating that tests of vestibular function concentrated on the VOR and VSR pathways only. 13 To date no studies have investigated the VCR pathways, as tested with cVEMPs, in subjects with HIV/AIDS. This lack of information may in apart be attributable to that fact that cVEMPs have only recently been included as part of clinical test-batteries for vestibular function having proved useful in identifying vestibular disorders.…”

Editorial

“…In 2012, the winning authors [6][7][8][9] were invited to London to present their work at the RSM. We thank our Assistant Editors Desmond Nunez, Musheer Hussain, Liam Flood and Pat Bradley for their work in selecting the winners of these awards.…”