Even with active antiretroviral therapy, some children living with HIV develop neurocognitive deficits and show neurodevelopmental delays. This can affect their ability to read, form relationships, and find productive employment. Detecting HIV-associated central nervous system (CNS) effects early, and following their progress reliably, is critical for studying, assessing, and treating this disabling HIV co-morbidity—particularly in the lower- and middle- income countries where most cases exist and resources are limited. We have been tracking literacy development and cognitive performance longitudinally in a cohort of children living with and without HIV (CLWH/CLWOH) in Dar es Salaam Tanzania. The focus is determining if tests of central auditory function (i.e., tests of the brain’s ability to process complex sounds) are associated with, or predict, the development of literacy, behavioral problems, and neurocognitive abilities. Results show that CLWH have worse neurocognitive performance, poorer literacy skills, and more behavioral problems on average than their non-infected age and socioeconomic status matched peers. Interestingly, central auditory test performance correlates with literacy and neurocognitive outcomes. Children who consistently perform better than their peers in detecting speech in background noise are more likely to read earlier than those who do not. Similarly, children with poor central auditory performance also have worse performance on cognitive tests of memory, attention, and processing speed. These results support our previous work showing that performance on tasks assessing the central auditory system correlate with tests of neurocognitive abilities. These longitudinal results suggest the tests might be predictive, where a central auditory test at a young age might help predict the subsequent development of literacy and at a later age. Children entered the current study at ages 3-8, now they will be entering adolescence. A key question is whether these tests might predict critical life outcomes such as school performance, mental health, and quality of life. Very few studies exist that follow CLWH into adolescence when CLWH take more responsibility for their care. This renewal will show how auditory tests relate to educational outcomes, mental health, and quality of life in a well-studied cohort of CLWH/CLWOH as they progress into adolescence. We have assembled an international team with experience in central auditory, neurocognitive, and neuropsychological testing. Dr. Nina Kraus and her team at Northwestern are internationally recognized experts in auditory electrophysiology. The Dar es Salaam team has extensive experience in performing both central auditory and neurocognitive tests and managing large-scale studies. Dr. Jonathan Lichtenstein is expert in assessing neurocognitive function and developmental delays in children. Together this team will track educational, mental health, and quality of life outcomes in CLWH and determine the role central auditory testing could play in predicting or assessing the neurocognitive effects of HIV infection. These tests may offer a new and improved way to assess critical life outcomes in adolescents living with HIV.

Project Narrative This combined cross-sectional and longitudinal study will show whether central auditory tests could offer value for assessing or predicting the central nervous system effects of HIV infection in children and adolescents. Diagnosing and monitoring of central nervous system co-morbidities is essential in HIV infection, and central auditory tests may offer a simpler, easier to perform way to assess this than current techniques. This could alter clinical practice if central auditory tests are shown to be useful for screening for or predicting central nervous system effects in children and adolescents living with HIV in resource-limited settings.