Maternal health, antiretroviral therapy exposure, and hearing outcomes in children born to women living with HIV: A descriptive analysis from South Africa

BACKGROUND: South Africa's high HIV prevalence presents unique challenges, including potential impacts on hearing function in children born to women with HIV. While antiretroviral therapy (ART) has significantly reduced vertical transmission of HIV, the combined influence of maternal health conditions and in utero HIV and ART exposure on childhood hearing outcomes remains poorly understood. Evidence regarding the contribution of maternal ART exposure and comorbidities to auditory outcomes among children who are HIV-exposed uninfected remains limited, particularly in African settings. AIM: This study aimed to examine hearing function in children born to women with HIV, with a specific focus on maternal ART exposure and comorbid health conditions. METHODS: A retrospective cross-sectional record review was conducted on 85 children aged 0 to 5 years born to women with HIV in Johannesburg, South Africa. Data included demographic details, audiological findings, and maternal health information. Descriptive and exploratory inferential analyses were conducted. RESULTS: Hearing loss prevalence was 16.5%, with 64.3% of cases classified as sensorineural and 35.7% as conductive. Abnormal tympanometry findings were present in 42.9% of affected children, suggesting middle ear involvement in some cases. Children whose mothers had diabetes or received protease inhibitor-based ART regimens demonstrated higher odds of hearing loss; however, these associations were imprecisely estimated and did not reach statistical significance (AOR = 2.7; 95% CI [0.8-8.9] for protease inhibitors; AOR = 3.2; 95% CI [0.9-11.5] for maternal diabetes). CONCLUSION: This descriptive study identified hearing loss among a subset of children born to women with HIV and observed possible patterns involving maternal ART exposure and maternal comorbidities. However, given the small sample size and referral-based sampling strategy, findings should be interpreted cautiously and not as evidence of causal associations. Further longitudinal studies are needed to inform risk-based preventive strategies accurately.