Aminoglycoside-induced hearing loss in HIV-positive and HIV-negative multidrug-resistant tuberculosis patients.
Background. Ototoxicity following aminoglycoside treatment for multidrug-resistant tuberculosis (MDR-TB) is a significant problem. This study documents the incidence of ototoxicity in HIV-positive and HIV-negative patients with MDR-TB and presents clinical guidelines relating to ototoxicity.  Methods. A prospective cohort study of 153 MDR-TB patients with normal hearing and middle ear status at baseline controlling for 6 mitochondrial mutations associated with aminoglycoside-related ototoxicity, at Brooklyn Chest Hospital in Cape Town. Pure tone audiometry was performed monthly for 3 months to determine hearing loss. HIV status was recorded, as was the presence of 6 mutations in the MT-RNR1 gene.  Results. Fifty-seven per cent developed high-frequency hearing loss. HIV-positive patients (70%) were more likely to develop hearing loss than HIV-negative patients (42%). Of 115 patients who were genetically screened, none had MT-RNR1 mutations.  Conclusion. Ototoxic hearing loss is common in MDR-TB patients treated with aminoglycosides. HIV-positive patients are at increased risk of ototoxicity. Auditory monitoring and auditory rehabilitation should be an integral part of the package of care of MDR-TB patients.
Department of Otolaryngology, Kimberley Hospital Complex; and Division of Otolaryngology, University of Cape Town Medical School. harristasneem@yahoo.com.
Tashneem
T
Harris
Soraya
S
Bardien
H Simon
HS
Schaaf
Lucretia
L
Petersen
Greetje
G
De Jong
Johannes J
JJ
Fagan
D000617:Aminoglycosides; D015331:Cohort Studies; D034381:Hearing Loss / Q000453:epidemiology; D006801:Humans; D011446:Prospective Studies; D013019:South Africa; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy
D000617:Aminoglycosides