Ototoxicity associated with use of nucleoside analog reverse transcriptaseinhibitors: A report of 3 possible cases and review of the literature

Although a variety of adverse effects have been attributed to treatment wit h nucleoside analog reverse transcriptase inhibitors (NRTIs) for human immu nodeficiency virus type 1 (HIV-1) infection, only 5 cases of ototoxicity ha ve been reported in the literature. We describe 3 additional cases of possi ble NRTI-associated ototoxicity in HIV-1-infected patients, all of whom wer e aged >45 years, had a history of noise-induced hearing loss, and reported tinnitus and deterioration in hearing in the setting of antiretroviral the rapy. Reductions in mitochondrial DNA content induced by NRTIs, as well as mitochondrial DNA mutations associated with aging and HIV-1 infection, all may contribute to auditory dysfunction in older patients with HIV-1 infecti on. Prospective studies are necessary to determine the incidence of tinnitu s and hearing loss among HIV-1-infected patients and their relationship to the use of NRTIs.