Reduced bilateral auditory cortex activation during pure-tone perception in pediatric HIV

Introduction: Children with perinatally acquired HIV (CPHIV) are at increased risk of neurodevelopmental difficulties, including hearing-related impairments, despite early initiation of antiretroviral therapy (ART). Previous studies have reported a higher prevalence of hearing loss in CPHIV compared with uninfected children; however, the contribution of the central auditory system to these auditory differences remains unclear. Understanding central auditory processing in CPHIV is important, as even subtle auditory difficulties during childhood can negatively affect speech and language development, academic performance, and quality of life. Methods: Functional MRI was used to examine neural responses to auditory stimulation in 108 11-year-old children (60 CPHIV and 48 children without HIV). During scanning, participants listened to pure tones at low (500 Hz), middle (1,500 Hz), and high (4,000 Hz) frequencies. Results: CPHIV demonstrated modestly elevated hearing thresholds (reflecting poorer hearing sensitivity) at several frequencies; however, the prevalence of clinically defined hearing loss did not differ between groups. Across all children, pure-tone stimulation elicited robust bilateral activation of the auditory cortices, with both the spatial extent and magnitude of activation decreasing as tone frequency increased. Relative to controls, CPHIV exhibited significantly reduced bilateral auditory cortex responses across frequencies. These group differences persisted after accounting for sex and handedness and after excluding children with hearing loss. Associations between hearing thresholds and auditory cortex activation were generally weak, except at 4,000 Hz in CPHIV, where poorer hearing was associated with stronger auditory cortex activation, consistent with a compensatory neural response. Discussion: Despite largely normal peripheral hearing, CPHIV receiving ART exhibited reduced bilateral auditory cortex responses during pure-tone processing. These findings suggest that alterations within the central auditory system may contribute to auditory vulnerability in CPHIV.