Abnormal QTc Syndrome in HIV-Infected Patients: A Systematic review of Prevalence and Risk Factors

Abstract

Background The purpose of this review is to critically analyse data regarding the prevalence and risk factors for developing a prolonged QTc interval and subsequent sudden cardiac death (SCD) in persons living with HIV (PLWH). Methods A systematic literature search using PubMed and Google Scholar databases was performed using the following search terms: ‘HIV and prolonged QTc’ and ‘managing HIV-patients with prolonged QTc’. References within articles of interest were also evaluated. Results/Discussion PLWH are at an increased risk of having a prolonged QTc interval. Some risk factors for this include the virus itself, concomitant medications, comorbid conditions, addictions and electrolyte disturbances. PLWH who have an increased HIV RNA viral load or decreased CD4+ T-cell count are at further risk for progressing to sudden cardiac death (SCD). Many medications commonly prescribed in the PLWH population, such as antiretrovirals and antimicrobials used in opportunistic infection prophylaxis, have also been shown to promote QTc prolongation through inhibition of human ether-a-go-go potassium channels or through drug metabolism inhibition of other QTc prolonging drugs. Conclusions Due to the high number of risk factors associated with QTc prolongation, clinicians should incorporate baseline and routine ECG monitoring for PLWH to potentially lower the increased risk of SCD in PLWH.

Prolonged QT Interval in SARS-CoV-2 Infection: Prevalence and Prognosis

“…Baseline QT interval abnormalities in the setting of SARS-Cov-2 infection can be secondary to the viral infection per se, the inflammatory state associated with SARS-Cov-2 infection, and ischemia or hypoxia [ 1 ]. Indeed, several viral infections like human immunodeficiency virus (HIV) and dengue have been independently associated with a prolonged QT interval [ 7 , 8 , 9 ]. Interestingly, acute coronavirus infection has been associated with a prolonged QT interval in rabbits [ 10 ], which suggests that the virus might have a direct effect on the heart.…”

Otherwise Unexplained Transient QTc Prolongation in a Patient Admitted with COVID Disease

“…This systemic inflammation via 3 Case Reports in Cardiology elevated IL-6 is itself an independent risk factor for QTc prolongation, by modulating cardiomyocyte ion channel expression [18]. Other viral illnesses have been reported to exhibit this effect-HIV seropositivity is associated with a prolonged QT [19]. Physiological changes in acute illness can also lead to a temporary ventricular repolarization abnormality-core body temperature can impact QT duration with moderate hypothermia causing temporary prolongation of the QTc as well as fever [20,21].…”

Opioid Use Disorders in People Living with HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders

“…The inhibition of CYP3A4 by PIs and integrase inhibitors increases the plasma concentration of methadone, leading to an increased therapeutic effect and methadone-induced toxicity [ 59 , 60 ]. Additionally, methadone can contribute to QTc prolongation and sudden cardiac death, through inadvertent inhibition of the human ether-a-go-go-related gene (hERG) potassium ion channels [ 7 ]. On the other hand, induction of CYP3A4 by NNRTIs, would lead to suboptimal plasma concentrations of methadone and might eventually cause therapeutic failure [ 8 , 60 ].…”

“…Numerous studies also described attrition along the HIV care continuum among HIV-infected drug users, including suboptimal HIV testing, delayed entry into HIV care, and initiation of antiretroviral therapy (ART) [ 1 , 2 ]. Additionally, PLWHA and OUD are also more likely to develop more severe viral progression, including neurological complications of HIV/AIDS [ 6 ], and are at risk for serious drug–drug interactions (DDI), through antiretroviral-opioid metabolic pathway-related interactions [ 7 , 8 ]. Barriers to OUD-treatment, such as medication-assisted therapy (MAT), are also apparent for PLWHA with OUD.…”