Prevalence and Correlates of Electrocardiographic Abnormalities in Adults With HIV: Insights From the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE)

Bloomfield, Gerald S.; Weir, Isabelle R; Ribaudo, Heather J.; Fitch, Kathleen V.; Fichtenbaum, Carl J.; Moran, Laura; Bedimo, Roger; Filippi, Christopher de; Piccini, Jonathan P; Zanni, Markella V.; Lu, Michael T.; Hoffmann, Udo; Grinspoon, Steven; Douglas, Pamela S.

doi:10.1097/qai.0000000000002877

Cited by 5 publications

(9 citation statements)

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“…Additional study is needed from across the region to determine whether the high burden of prior MI and myocardial ischemia observed via ECG in PWH in Tanzania is representative of other countries in the region. Notably, the prevalence of ischemic ECG findings observed among PWH in our study is higher than reported in a globally representative low-moderate risk HIV infected population, but similar to what has been reported in older-aged cohorts from Europe and North America [28,29]. The fact that we observed a similar prevalence of ischemic ECG findings in a younger cohort in Tanzania raises the possibility that other factors, such as cardiomyopathies, malnutrition, and poorly-controlled hypertension, may be contributing to the abnormal ECG findings in our study population.…”

Section: Discussionsupporting

confidence: 87%

Prevalence and Correlates of Ischemic ECG Findings among Adults With and Without HIV in Tanzania

et al. 2022

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Introduction: HIV confers increased risk of myocardial infarction (MI), but there has been little study of ischemic electrocardiogram (ECG) findings among people with HIV in sub-Saharan Africa. Objectives: To compare the prevalence of ischemic ECG findings among Tanzanians with and without HIV and to identify correlates of ischemic ECG changes among Tanzanians with HIV. Methods: Consecutive adults presenting for routine HIV care at a Tanzanian clinic were enrolled. Age- and sex-matched HIV-uninfected controls were enrolled from a nearby general clinic. All participants completed a standardized health questionnaire and underwent 12-lead resting ECG testing, which was adjudicated by independent physicians. Prior MI was defined as pathologic Q-waves in contiguous leads, and myocardial ischemia was defined as ST-segment depression or T-wave inversion in contiguous leads. Pearson’s chi-squared test was used to compare the prevalence of ECG findings among those with and without HIV and multivariate logistic regression was performed to identify correlates of prior MI among all participants. Results: Of 497 participants with HIV and 497 without HIV, 272 (27.8%) were males and mean (sd) age was 45.2(12.0) years. ECG findings suggestive of prior MI (11.1% vs 2.4%, OR 4.97, 95% CI: 2.71–9.89, p < 0.001), and myocardial ischemia (18.7% vs 12.1% OR 1.67, 95% CI: 1.18–2.39, p = 0.004) were significantly more common among participants with HIV. On multivariate analysis, ECG findings suggestive of prior MI among all participants were associated with HIV infection (OR 4.73, 95% CI: 2.51–9.63, p = 0.030) and self-reported family history of MI or stroke (OR 1.96, 95% CI: 1.08–3.46, p = 0.023). Conclusions: There may be a large burden of ischemic heart disease among adults with HIV in Tanzania, and ECG findings suggestive of coronary artery disease are significantly more common among Tanzanians with HIV than those without HIV.

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Section: Discussionsupporting

confidence: 87%

Prevalence and Correlates of Ischemic ECG Findings among Adults With and Without HIV in Tanzania

et al. 2022

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“…Our study also found the odds of QTc interval prolongation increased by 7% for every year increase in age. Apart from aging, ethnicity might play a role as supported by the result of REPRIEVE study that Asian PWH had two time higher odd of prolonged QTc than other ethnicities [30].…”

Section: Discussionmentioning

confidence: 94%

Higher prevalence of QTc interval prolongation among virologically suppressed older people with HIV

Theerasuwipakorn

Rungpradubvong

Chattranukulchai

et al. 2022

Aids

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Anchalee Avihingsanon d,g , HIV-NAT 006 and 207 study teams Objective: To assess the prevalence, and factors associated with QTc interval prolongation, among 383 virologically suppressed people with HIV (PWH), without evidence of cardiovascular disease and active opportunistic infections in Thailand.Design: Cross-sectional study.Methods: Resting 12-lead digital ECGs were performed in 2019. QT interval corrected for heart rate (QTc) >450 ms in males and >460 ms in females was defined as QTc interval prolongation. We used multivariable logistic regression to investigate factors associated with QTc interval prolongation.Results: Mean (standard deviation) age was 56 (5.5) years and 42% were female. The median current CD4þ was 619 (interquartile range [IQR] 487, 769) cells/mm 3 . The median duration of antiretroviral therapy (ART) was 11.9 (IQR 7.1-16.1) years. Commonly used ART were rilpivirine (37.9%), efavirenz (20.1%), atazanavir/ritonavir (15.7%), lopinavir/ritonavir (12.3%) and dolutegravir (5%). The prevalence of QTc interval prolongation was 22.7%. In multivariable analysis, older age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12, P ¼ 0.005), female sex (OR 1.69, 95% CI 1.01-2.82, P ¼ 0.046) and increasing BMI (OR 1.08, 95% CI 1.01-1.15, P ¼ 0.03) were associated with QTc interval prolongation. With every 1-year increase in age, the odds of QTc interval prolongation increased by 7%. Conclusions:In this well-suppressed aging Asian HIV cohort, the prevalence of QTc interval prolongation was relatively high, and associated with increasing age, female sex, and higher BMI. For PLWH with these characteristics, QTc interval should be monitored before and after initiating any medications known to prolong QTc intervals, to prevent fatal cardiac arrhythmias.

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“…One recent study reported a 1.6% incidence of new QT prolongation within 2 years among virally suppressed PLWH [71 ▪ ]. Relatively high prevalences of early repolarization abnormalities (12.4%) and electrocardiographic left ventricular hypertrophy (8.3%) were also recently reported in the multinational Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) Study [66 ▪ ]. While studies in the general population suggest the association between electrocardiographic early repolarization [72] and left ventricular hypertrophy with SCD [73], long term clinical follow-up is required to determine clinical significance in PLWH (Table 2).…”

Section: Subclinical Disease Measures and Risk Of Ventricular Arrhyth...mentioning

confidence: 87%

“…Several studies report longer absolute corrected QT and QT subcomponent intervals among PLWH versus controls, both in developed and low income countries [64,65,66 ▪ ,67,68,69 ▪ ]. Risk factors for prolonged QT in PLWH include male sex [66 ▪ ], Asian race [66 ▪ ], high HIV viral load [63,65,66 ▪ ], lower CD4 count [63,65], ART use [69 ▪ ], and increased inflammatory biomarker levels [64,68]. The data correlating specific ART classes and QT prolongation are conflicting but support increased risk with older generation protease inhibitors, efavirenz, and rilpivirine [65,70].…”

Section: Subclinical Disease Measures and Risk Of Ventricular Arrhyth...mentioning

confidence: 99%

“…PLWH may be susceptible to prolonged ventricular repolarization, as measured by the electrocardiographic QT interval, due to direct HIV viral effects on cardiac ion channels [58], side effects of ART [59], drug-drug interactions between ART and other medications known to increase QT interval duration [60], and substances such as opioids [61]. Prevalent QT prolongation ranges from 3–23% [62–65,66 ▪ ]. Several studies report longer absolute corrected QT and QT subcomponent intervals among PLWH versus controls, both in developed and low income countries [64,65,66 ▪ ,67,68,69 ▪ ].…”

Section: Subclinical Disease Measures and Risk Of Ventricular Arrhyth...mentioning

confidence: 99%

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Prevention of heart failure, tachyarrhythmias and sudden cardiac death in HIV

Woldu

Post

et al. 2022

Current Opinion in HIV and AIDS

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Purpose of reviewTo summarize the state-of-the-art literature on the epidemiology, disease progression, and mediators of heart failure, tachyarrhythmias, and sudden cardiac death in people living with HIV (PLWH) to inform prevention strategies.Recent findingsRecent studies corroborate the role of HIV as a risk enhancer for heart failure and arrhythmias, which persists despite adjustment for cardiovascular risk factors and unhealthy behaviors. Immune activation and inflammation contribute to the risk. Heart failure occurs more frequently at younger ages, and among women and ethnic minorities living with HIV, highlighting disparities. Prospective outcome studies remain sparse in PLWH limiting prevention approaches. However, subclinical cardiac and electrophysiologic remodeling and dysfunction detected by noninvasive testing are powerful disease surrogates that inform our mechanistic understanding of HIV-associated cardiovascular disease and offer opportunities for early diagnosis.SummaryAggressive control of HIV viremia and cardiac risk factors and abstinence from unhealthy behaviors remain treatment pillars to prevent heart failure and arrhythmic complications. The excess risk among PLWH warrants heightened vigilance for heart failure and arrhythmic symptomatology and earlier testing as subclinical abnormalities are common. Future research needs include identifying novel therapeutic targets to prevent heart failure and arrhythmias and testing of interventions in diverse groups of PLWH.

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Prevalence and Correlates of Electrocardiographic Abnormalities in Adults With HIV: Insights From the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE)

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 5 publications

References 60 publications

Prevalence and Correlates of Ischemic ECG Findings among Adults With and Without HIV in Tanzania

Prevalence and Correlates of Ischemic ECG Findings among Adults With and Without HIV in Tanzania

Higher prevalence of QTc interval prolongation among virologically suppressed older people with HIV

Prevention of heart failure, tachyarrhythmias and sudden cardiac death in HIV

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