HIV/AIDS affects millions of people. Many symptoms of HIV affect the auditory (hearing) system, as a result of the direct effect of the HIV infection or indirectly due to opportunistic infections or treatments that are ototoxic. According to Heinze et al, as many as 75% of adults with HIV/AIDS may develop auditory disturbances, and 50% vestibular disturbances (Heinze et al, 2011). In children, 38.8% of 139 HIV infected children in Peru had hearing impairment, mainly associated with middle ear disease, prior cerebral infection and low C4 count. (Chao et al, 2011).
In our practice, it has been our observation that persons with stable HIV/AIDS, often have some mild unsteadiness, but we do not think that there is a particularly high prevalence of vestibular disturbances. Rather, it is our impression that persons with stable treated HIV/AIDS, resemble the rest of the population.
The general signs of vestibular dysfunction are vertigo and unsteadiness. These symptoms are not entirely specific to the inner ear, and may also be caused by a variety of other processes that are prevalent in the HIV population as well as the normal population, such as migraine, low blood pressure, anxiety, and peripheral neuropathy.
There are no tests that specifically identify HIV related vestibulopathy. The situation rather is that we have a large number of sensitive nonspecific tests for vestibular disorders.
Tests for central disturbances -- i.e. brain or brainstem dysfunction, range from highly specific MRI scans, to highly nonspecific functional assessments of visual tracking or psychological function. Nonspecific test may also reflect the influence of cognitive variables such as depression or inattention, and medication side effects.
Some authors have suggested that there is a very high incidence (82%) of cerebello-vestibular pathway involvement in symptomatic HIV patients (Castello et al, 1998). We are very dubious, and think rather that Castello used unreasonably sensitive tests. Similarly, Teggi et al used an unreasonably sensitive test (Dynamic Gait Index) to conclude that 40% had both abnormal peripheral and central vestibular findings. We also find this to be highly unlikely.
In end stage HIV/AIDS, the picture is dominated by opportunistic infections and tumors. In these patients, the prevalence of dizziness is high, as individuals are extremely ill. In such situations, dizziness or hearing disorders are primarily due to central lesions in critical brain circuits (e.g. Hoistad and Hain, 2003).
Treatment of peripheral vestibular function in HIV/AIDS is identical to that of persons without HIV/AIDS. Treatment of central vestibular dysfunction largely consists of vestibular physical therapy.