Association of electrocardiogram abnormalities in human immunodeficiency virus infected patients with special reference to QTc interval

Gaharwar, Rakesh; Molke, Swapnil B.; Singh, Ajay Pal; Jatav, O. P.

doi:10.18203/2349-3933.ijam20151013

Cited by 3 publications

(8 citation statements)

References 11 publications

(20 reference statements)

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“…The HIV+ and HIV-negative groups were similar across most sociodemographic, cardio-metabolic, and cardio-autonomic indices. Studies examining HIV-specific risk factors for QTc prolongation mainly implicate antiretroviral regimen and CD4 count (Chinello et al, 2007; Charbit et al, 2009; Shavadia et al, 2012; QaQa et al, 2010; Ige et al, 2014; Wongcharoen et al, 2014; Gaharwar et al, 2017). Although the sample of patients may be too small to extrapolate findings to the general HIV population, it should be noted that the sample mostly had an undetectable viral load, the average CD4 counts was in the mid-range of illness, i.e., 458.83 cells/mm3, and only 50% of the sample reported protease inhibitor use.…”

Section: Discussionmentioning

confidence: 99%

“…If these structures are indeed involved in the regulation of sympathetic and parasympathetic tone then it is conceivable QTc interval length might reflect their functional connectivity. In addition, prolongation of the QTc interval in HIV+ individuals has been most consistently linked to cardio-metabolic disease comorbidity (Reinsch et al, 2009), antiretroviral therapy regimen (Chinello et al, 2007; Charbit et al, 2009; Shavadia et al, 2012), and CD4 decline (QaQa et al, 2010; Ige et al, 2014; Wongcharoen et al, 2014; Gaharwar et al, 2017). The aim of the current study was to determine the brain regions whose rsFC with the VMPFC corresponds to QTc interval length; whether these regions differ between HIV patients on stable antiretroviral therapy (ART) and HIV-negative comparison subjects; and whether these rsFC patterns vary as a function of CD4 count in the HIV+ patients.…”

Section: Introductionmentioning

confidence: 99%

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Reduced functional connectivity between ventromedial prefrontal cortex and insula relates to longer corrected QT interval in HIV+ and HIV− individuals

McIntosh

Chow

Lum

et al. 2017

Clinical Neurophysiology

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Objective Prolongation of the QT interval, i.e., measure of the time between the start of the Q wave and the end of the T wave, is a precursor to fatal cardiac arrhythmias commonly observed in individuals infected with the Human Immunodeficiency Virus (HIV), and is related to dysregulation of the autonomic nervous system. We investigated the relationship between QT interval length and resting state functional connectivity (rsFC) of the ventromedial prefrontal cortex (VMPFC), a core region of the brain that is involved with cardio-autonomic regulation. Method Eighteen HIV+ men on antiretroviral therapy and with no history of heart disease were compared with 26 HIV-negative control subjects who had similar demographic and cardio-metabolic characteristics. A seed-based rsFC analysis of the right and left VMPFC was performed at the individual subject level, and 2nd-level analyses were conducted to identify the following: group differences in connectivity, brain regions correlating with corrected (QTc) interval length before and after controlling for those group differences, and regions where seed-based rsFC correlates with CD4 count and QTc interval within HIV+ individuals. Results HIV-negative adults showed greater rsFC between the VMPFC seed regions and several default mode network structures. Across groups greater rsFC with the left anterior insula was associated with shorter QTc intervals, whereas right posterior insula connectivity with the VMPFC correlated with greater QTc intervals. HIV patients with lower CD4 counts and higher QTc intervals showed greater rsFC between the right VMPFC and the right posterior insula and dorsal cingulate gyrus. Conclusions This study demonstrates that QTc interval lengths are associated with distinct patterns of VMPFC rsFC with posterior and anterior insula. In HIV patients, longer QTc interval and lower CD4 count corresponded to weaker VMPFC connectivity with the dorsal striatrum. Significance A forebrain control mechanism may be implicated in the suppression of cardiovagal influence that confers risk for ventricular arrhythmias and sudden cardiac death in HIV+ individuals.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reduced functional connectivity between ventromedial prefrontal cortex and insula relates to longer corrected QT interval in HIV+ and HIV− individuals

McIntosh

Chow

Lum

et al. 2017

Clinical Neurophysiology

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“…The authors hypothesized that this was the result of disease progression in prolonged QTc syndrome given an absence of QTc prolonging drugs and electrolyte abnormalities. Additional data suggest that HIV disease progression, marked by decreasing CD4 + T-cell count and increasing HIV RNA viral load, are independently associated with the presence of and increasing degree of a prolonged QTc interval [5,9,15,17,18]. Duration of HIV infection has been associated with QTc prolongation [9].…”

Section: Qtc Interval Prolongationmentioning

confidence: 99%

“…There is discordance in previously published literature on the impact of ART and other HIV-associated medications on the development of SCD in PLWH. Older literature indicates that protease inhibitor (PI)-based regimens and some opportunistic infection (OI) treatment regimens are more likely to cause a prolonged QTc interval than alternative regimens [10,17]; while, more recently published literature indicates that there is no association between ART and QTc prolongation [7,15]. Compared with uninfected controls, mean QTc interval was significantly longer in PLWH receiving ART for a mean 1.5 ±2 years with mean CD4 + T-cell count 440 ±188 cells/mm 3 (409 ±21 versus 421 ±21 msec; respectively; P=0.002) [14].…”

Section: Qtc Interval Prolongationmentioning

confidence: 99%

“…However, the association between QTc prolongation and SCD in PLWH remains poorly understood. Several studies have identified characteristics associated with QTc prolongation in PLWH, however, there is discordance among these studies [5,9,10,14,15]. Therefore, the purpose of this review is to critically analyse data regarding the prevalence and risk factors for developing a prolonged QTc interval and subsequent SCD in PLWH.…”

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confidence: 99%

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

2018

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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.

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HIV and Antiretroviral Therapy Are Independently Associated with Cardiometabolic Variables and Cardiac Electrical Activity in Adults from the Western Cape Region of South Africa

Williams

Kamau

Everson

et al. 2021

JCM

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Cardiovascular-related complications are on the rise in people with HIV/AIDS (PWH); however, the relationship among HIV and antiretroviral therapy (ART)-related parameters, cardiovascular risk, and cardiac electrical activity in PWH remain poorly studied, especially in sub-Saharan African populations. We investigated whether HIV and ART are associated with cardiometabolic and cardiac electrical activity in PWH from Worcester in the Western Cape Province, South Africa. This was a cross-sectional study with HIV-negative (HIV−, n = 24) and HIV-positive on ART (HIV+/ART+, n = 63) participants. We obtained demographic, lifestyle, and medical history data and performed anthropometric, clinical assessments, and blood/urine biochemistry. We performed multiple stepwise linear regression analyses to determine independent associations among HIV, ART, cardiometabolic, and electrocardiographic (ECG) variables. HIV+/ART+ independently associated with a lower body mass index (p = 0.004), elevated gamma-glutamyl transferase levels (β: 0.333 (0.130–0.573); p = 0.002), and elevated alanine aminotransferase levels (β: 0.427 (0.224–0.629); p < 0.001) compared to HIV−. Use of second-line ART was positively associated with high-sensitivity C-reactive protein (p = 0.002). Although ECG parameters did not differ between HIV− and HIV+/ART+, viral load positively associated with p-wave duration (0.306 (0.018–0.594); p = 0.038), and longer HIV duration (≥5 years) with ST-interval (0.270 (0.003–0.537); p = 0.047) after adjusting for confounding factors. Our findings suggest that HIV and ART are associated with mixed effects on this population’s cardiometabolic profile and cardiac electrical activity, underpinning the importance of cardiovascular risk monitoring in PWH.

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Association of electrocardiogram abnormalities in human immunodeficiency virus infected patients with special reference to QTc interval

Cited by 3 publications

References 11 publications

Reduced functional connectivity between ventromedial prefrontal cortex and insula relates to longer corrected QT interval in HIV+ and HIV− individuals

Reduced functional connectivity between ventromedial prefrontal cortex and insula relates to longer corrected QT interval in HIV+ and HIV− individuals

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

HIV and Antiretroviral Therapy Are Independently Associated with Cardiometabolic Variables and Cardiac Electrical Activity in Adults from the Western Cape Region of South Africa

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