Ototoxicity may be associated with protease inhibitor therapy.

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Abstract
Sir—Simdon et al. [1] report 3 cases of ototoxicity associated with the use of nucleoside reverse-transcriptase inhibitors (NRTIs) in patients infected with HIV type 1 (HIV-1). They report that this brings to 8 the number of such cases reported in the literature, and they propose that mitochondrial toxicity, which is currently implicated in a wide variety of adverse conditions associated with NRTI therapy [2], is a possible cause. In support of this, they note the absence of case reports of ototoxicity associated with protease inhibitor use. I report here, however, a case in which auditory dysfunction was temporally associated with the use of lopinavir-ritonavir.