Diagnostic Value of Screening Questions for Vestibular Dysfunction in HIV Disease: A Pilot Study

Abstract

**Introduction:** A number of vestibular function tests have been used to evaluate vestibular symptoms among people living with HIV (PLWH). However, these tests are inconsistent due to poor sensitivity and specificity. This study attempts to identify sensitive and specific vestibular symptoms that may be useful in selecting appropriate HIV-positive adults for clinical vestibular function tests.\n\n**Methods:** Participants were enrolled from the Baltimore-Washington, DC, site of the Multicenter AIDS Cohort Study and the Washington, DC, site of the Women s Interagency HIV Study. A total of 246 participants were evaluated using the Dix-Hallpike (DH) maneuver and the eyes closed, standing on foam (ECF) position in the Romberg test, and completed the Adult Balance and Dizziness Supplemental questionnaire of the 2008 National Health Interview Survey. The sensitivity and specificity were calculated using self-reported vestibular dysfunction from the questionnaire data compared with vestibular dysfunction determined by clinical testing.\n\n**Results:** Sixty participants (24.4%) reported vestibular dysfunction. The prevalence of abnormal tests was 40.8% for DH--any nystagmus, 1.5% for DH--classical nystagmus, 40.3% for DH--nonclassical nystagmus, 38.3% for gaze-evoked nystagmus, and 15.7% for Romberg ECF. Sensitivity of self-reported vestibular symptoms for all vestibular function tests reported ranged from 23.1% to 50.0%. These symptoms were moderately specific and ranged from 73.3% to 77.9%.\n\n**Conclusions:** Despite adequate specificity, the low sensitivity of self-reported symptoms of vestibular dysfunction were not useful to rule out a vestibular disorder in this sample of middle-aged PLWH. Therefore, clinical testing is needed to confirm the diagnosis of a vestibular disorder in the management of HIV disease.