Hearing function in virologically suppressed persons living with HIV: Results from the HELO study

Hearing function is highly sensitive to aging and may represent a marker of neuro-sensory decline. Whether well-controlled HIV infection is associated with altered auditory function remains uncertain.

Cross-sectional exposed-non-exposed study including 100 antiretroviral therapy (ART)-treated persons living with HIV (PLHIVs) (≥10 years of infection and ≥5 years of sustained viral suppression <20 copies/mL) and 95 age- and sex-matched HIV-uninfected controls (HUCs). All participants underwent comprehensive audiological assessment including pure-tone audiometry, speech audiometry, auditory brainstem responses (ABR), and brain magnetic resonance imaging (MRI). Analyses were adjusted for age using multivariable models.

To assess peripheral and brainstem auditory function in PLHIVs with long-term, tightly controlled virological suppression compared with HUCs. The primary objective was to compare pure-tone hearing thresholds in the better-hearing ear.

No clinically meaningful differences were observed between groups in pure-tone thresholds, speech audiometry parameters, ABR findings, or MRI small-vessel disease features. Mean air-conduction thresholds were 26.4±10.2dB in PLHIVs and 27.1±9.8dB in HUCs (P=0.52). Age-adjusted analyses showed no association between HIV status and auditory outcomes despite longstanding HIV infection. ABR wave latencies and interpeak intervals were comparable across groups. No significant correlation was found between auditory measures and global cognitive performance. Although some speech audiometry differences reached nominal significance levels, none met the predefined conservative significance threshold used to account for multiple testing.

Peripheral and brainstem auditory function were similar in virologically suppressed PLHIVs and HUCs. These findings suggest that, under current treatment conditions, well-controlled HIV infection is not associated with clinically meaningful peripheral or brainstem auditory dysfunction. Subtle auditory alterations cannot be completely excluded and may require more sensitive longitudinal or speech-in-noise assessments.