Central auditory tests reveal deficits in HIV treatment.

BACKGROUND: In Sub-Saharan Africa, where HIV is prevalent and neurocognitive screening tools are limited, central auditory tests (CATs) may provide an accessible way to detect neurocognitive deficits. This study examined the relationship between CAT performance and cognitive performance in people with (PLWH) and without HIV (PLWOH) in Dar es Salaam, Tanzania, with a focus on body mass index (BMI), a potential marker of HIV severity. We hypothesized that low BMI would correlate with more severe HIV and greater CAT and cognitive impairment. METHODS: We analyzed cross-sectional data from two longitudinal studies involving individuals with and without HIV in Tanzania. Participants completed CATs and cognitive assessments. For this analysis, we used data from participants' most recent assessments. CATs assess the brain's ability to process sound, correlate with broader cognitive function, and require rapid processing and sustained attention. Sociodemographic, antiretroviral therapy (ART) history, and anthropometric data were collected through questionnaires and clinical records. Linear regression models assessed the associations between BMI, ART regimen, and HIV status on CAT and cognitive performance. RESULTS: Contrary to our hypothesis, higher BMI was associated with poorer CAT and cognitive performance among participants with HIV. The use of fat-soluble ART drugs was linked to worse outcomes. CONCLUSION: Higher body fat may lead to underdosing of fat-soluble ART drugs when fixed-dose combinations are used. These findings suggest that CATs may be sensitive to variation in clinical and treatment-related factors in this population. CATs may represent a feasible, low-resource complement to traditional cognitive assessments for detecting subtle differences in function among individuals with HIV.