Is there a need for ototoxicity monitoring in patients with HIV/AIDS?


Khoza-Shangase Katijah

This paper reviews published research on hearing loss in adults with HIV/AIDS with a special focus on the possibility of ototoxicity of the medications used in clinical management of this population. Findings from all published papers on the subject, which include but are not limited to case reports, cross-sectional, as well as longitudinal studies where ototoxicity monitoring of patients on antiretroviral therapy (ART) was conducted, are presented. The author offers an introduction to hearing loss in HIV/AIDS with reference to the primary effects of the disease itself as well as effects of opportunistic infections on the auditory function, before delving into iatrogenic hearing loss due to ART and other therapies that this population gets exposed to; and while doing so highlights the need for establishment and implementation of ototoxicity monitoring protocols as part of routine clinical management in Africa; as well as putting forward a recommendation of placing auditory function of adults with HIV/AIDS in developing countries on the healthcare and research agenda. Review of the literature in this field reveals that ototoxicity in adults with HIV/AIDS does exist; although minimal reporting of this morbidity is available in the academic literature. Literature also indicates that the reported causes as well as contributing factors to ototoxicity are varied. Documented information on ART ototoxicity is mainly of case reports, and where bigger samples are described; the studies are based on retrospective cross sectional data review with many of these studies lacking the use of sensitive audiological monitoring tools. Moreover, reports reviewed have mainly been international reports, with only one from Africa. Evidence on ototoxicity related to ART is sparse, however literature reviewed and studies presented highlight the need for intensified research into this area, particularly in developing countries where the volume of evidence is even less; despite these countries being the hardest hit by the pandemic with exposure to ART being an increasing phenomenon.

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