Words-in-Noise Test Performance in Young Adults Perinatally HIV Infected and Exposed, Uninfected

Abstract

Purpose The purpose of this study was to compare Words-in-Noise (WIN) data between young adults with perinatal HIV (PHIV) infection and those with PHIV exposure but uninfected (PHEU) and to evaluate associations between antiretroviral therapy (ART) exposures and WIN data. Method The WIN test and cognitive function were assessed in participants of the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol Up. Impaired WIN (IWIN) performance was defined as a signal-to-babble ratio of > +10 dB. Cognitive function was determined based on fluid cognition composite scores (FCCSs) and crystallized cognition composite scores, and < 70 was considered a fluid or crystallized cognitive impairment. Log binomial models were used to calculate the relative risks of IWIN between PHIV and PHEU. Results PHIV ( n = 334) and PHEU ( n = 52) participants had similar WIN thresholds and IWIN percentages. For young adults with FCCS ≥ 70, participants with PHIV were less likely to have IWIN for the better ear and worse ear as compared to participants with PHEU. For young adults with FCCS < 70, there was no association between HIV status and risk of IWIN for the better ear or worse ear. For those adults with crystallized cognition composite score of ≥ 70, young adults with PHIV were less likely to have IWIN for the better ear than young adults with PHEU; there was no association between HIV status and IWIN for the worse ear. For young adults with PHIV without a Centers for Disease Control and Prevention Class C diagnosis, a longer combination ART duration was associated with a higher risk of IWIN for the better ear. Conclusions For those without cognitive impairment, young adults with PHEU had poorer WIN thresholds than those young adults with PHIV. In young adults with PHIV who had no prior Centers for Disease Control and Prevention Class C diagnosis, a longer combination ART duration was associated with IWIN only in the better ear.

Auditory and cognitive function in older adults living with and without HIV

“…Others have used central auditory processing measures including speech in noise testing and gap detection. For speech in noise testing, researchers either only tested PWH [22] or compared young adults living with HIV with those young adults who were perinatally HIV exposed but uninfected [23]. In the latter study, results were similar to those in the current study such that the ability to identify speech in noise was similar between the two groups [23].…”

“…There was no difference in central auditory processing between PWH and PWoH who were matched on cognitive impairment status. Others have used different measures of central auditory processing [4,22,23], the current study is the first to evaluate DDT in PWH. Others have used central auditory processing measures including speech in noise testing and gap detection.…”

Hearing Loss in Offspring Exposed to Antiretrovirals During Pregnancy and Breastfeeding

“…PHEU children are therefore unable to benefit from the early intervention they would have received had these hearing differences been caught at birth. There is evidence linking short-term minimal hearing losses from otitis media to long-term auditory processing difficulties (Moore et al, 2020 ), and so it is possible that persistent minimal hearing losses like those seen in this study could result in the auditory processing difficulties described by Torre et al ( 2020 ).…”

“…This may help to clarify the currently mixed findings in the literature for PHEU children. The Torre group found impaired auditory processing in young adults who had been exposed to HIV and HAART in utero (Torre et al, 2020 ), but did not find an increased rate of failed hearing screenings in children exposed to HIV and HAART in utero (Torre et al, 2017 ). These findings could indicate that children exposed to HAART in utero are not at increased risk for clinically-significant hearing loss, but are at risk for other auditory processing difficulties.…”

“…The authors also noted that a number of HAART drugs demonstrated an incredibly wide range of variability in auditory outcomes for newborns, even after controlling for factors that often contribute to failed hearing screenings (Torre et al, 2017 ). Despite the lack of differences in hearing screening results at birth, the Torre group also found that PHEU young adults were more likely to have impaired words-in-noise performance with otherwise normal cognition than young adults with HIV, suggesting an effect of exposure to these drugs during pregnancy and breastfeeding (PaB) not seen from post-natal exposures (Torre et al, 2020 ).…”