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Ototoxicity associated with anti-retroviral therapy in Botswana: Case report / review Nwankwo N, Pillai B, Wester W, Bussmann H, Avalos A, Thior I, Marlink, R, Essex M, Moffat H Bostwana - Harvard Aids Institute Partnership for HIV Education and Research, Princess Marina Hospital, Gaborone, Botswana BACKGROUND The use of antiretroviral therapy has been associated with several well-documented adverse effects. However, there have been only eight reports in the literature of ototoxicity associated with the use of nucleoside analogues. Antecedent ear disease and age have been suggested as a predisposing factors. It has also been postulated that this uncommon adverse effect of nucleosides, is secondary to mitochondrial toxicity with cochlear damage. All the previous case reports were from the USA or Europe. We now present a case of an HIV-infected patient in Botswana, who developed hearing loss following the initiation of antiretroviral therapy. The Botswana National Antiretroviral Treatment Program has the largest cohort of HIV patients on public treatment in Africa. We are thus in a unique position to monitor the response to antiretrovirals in this setting. METHODS Case review of existing Medical Records were carried out, with web-based literature search. RESULTS We present a 36 year-old HIV-infected male, who was seen in our Infectious Diseases Clinic on 24/07/02 with a CD4 count of 3 cells/mm3, and viral load of 377,000 copies/mm3. He denied previous history ear disease, and otological examination was normal. He was started on CBV and EFV on 22/08/02, and his course was uneventful until 19/09/02, when he complained of right hearing loss with tinnitus. Neurological examination was unremarkable. RPR was negative. Audiometry revealed moderately severe, right sensori-neural hearing deficit of 55dB, which has remained unresolved. CONCLUSIONS / RECOMMENDATIONS The onset of hearing loss about one month after initiation of treatment with a nucleoside analogue- containing regimen, in a patient with no hearing deficit at baseline, strongly suggests drug-related toxicity. While further prospective studies in a larger cohort are required, we would suggest that patients on nucleosides should be monitored longitudinally for possible auditory dysfunction. |