Relationship of Hearing Impairment in Patients with Lamivudine Therapy: A Systematic Review and Meta-analysis

Abstract

Introduction: Lifelong Antiretroviral Therapy (ARVT) in patients with Human Immunodeficiency Virus (HIV) infection damages cochlea. Hearing Loss (HL) has been reported with lamivudine therapy in both HIV and/or Hepatitis B Virus (HBV) infections. Hence, the benefit of lamivudine therapy in individuals affected by these infections and risk of development of HL needs to be studied to make an adequate benefit-risk assessment. Aim: To evaluate the relationship of hearing impairment in patients treated with lamivudine and diagnosed with either HIV or HBV infection. Materials and Methods: The present study is a systematic review in which English-language publications that assessed HL in patients who are on lamivudine drug therapy were included. The types of studies included were: prospective studies, retrospective studies, case reports and case series. A comprehensive database search (PubMed, PubMed Central, Cochrane review, Google scholar and Embase) was conducted to identify the relevant literature published on HL and were searched for keywords related to lamivudine and HL- ‘lamivudine and hearing loss’, ‘lamivudine and deafness’, ‘lamivudine and hypoacusis’, ‘lamivudine and hearing impairment’ and ’lamivudine and ototoxicity’ for searching the data. The publications were independently reviewed and assessed for study quality and the data (title, author, year of publication, study design, study setting, population characteristics) extraction was done. Results: Out of 1,778 publications found at the initial stage, nine were included in the systematic review and quantitative metaanalysis. The majority (4/9) were cross-sectional studies. The prevalence of hearing impairment defined as per the protocol was 41% (total population 1,548). The I2 statistic was used to test statistical heterogeneity, with values of >50% representing important heterogeneity, then a random-effects model was used to perform the meta-analysis. A subgroup analysis was performed for the age group ≤18 years and >18 years. All analyses were conducted using the R software version 4.1.0. It was found that most of the studies (8/9) suffered moderateserious overall risk across all the domains of ROBINS-1 tool. Conclusion: This study showed a positive association of HL with lamivudine in patients with HIV infection.