In this cross-sectional study, an audiological assessment was performed on a cohort of human immunodeficiency virus (HIV)+ and HIV− adults in Tanzania. HIV+ subjects had lower distortion product otoacoustic emission levels than HIV− subjects, but audiometric thresholds did not differ. No effect due to tuberculosis treatment was seen. Within the HIV+ group, subjects on antiretroviral therapy (ART) reported greater difficulty both hearing speech in noise and understanding speech. They also had higher gap-detection thresholds. Distortion product otoacoustic emissions and audiometric thresholds did not differ between ART+ and ART− groups. The ART+ group showed changes consistent with a reduction in central auditory processing abilities.