Prevalence and Factors Associated with a Prolonged QTc Interval in a Cohort of Asymptomatic HIV-Infected Patients

Abstract

We aimed to determine the prevalence of a prolonged QTc interval in HIV-infected patients and its related factors through an observational study of a cohort of asymptomatic HIV-infected outpatients. All patients underwent a standard 12-lead electrocardiogram and a transthoracic echocardiogram. Prolonged QTc was considered if it was >440 ms in men and >450 ms in women. Epidemiological, clinical, and laboratory data were collected and the patients completed a questionnaire about cardiovascular risk factors. The analysis of the potential risk factors for prolonged QTc was done by multivariate logistic regression. The study included 194 patients, 84% men, with a mean age of 46.3 years. The mean duration of HIV infection was 122.6 months and 27.8% had AIDS. Antiretroviral therapy was being taken by 185 (96.4%) patients, and 92.4% of them had an undetectable viral load. The mean CD4 lymphocyte count was 553/mm(3). A total of 24 (12.4%) patients had a prolonged QTc interval, with a mean QTc of 456 ms. The factors associated with a prolonged QTc were hyperlipidemia (OR 3.7, 95% CI: 1.3-10.3; p=0.01) and diastolic dysfunction (OR 6.7, 95% CI: 2.4-18.3; p=0.0001), while the use of atazanavir was associated with a lower likelihood of having a prolonged QTc (OR 0.11, 95% CI: 0.02-0.5; p=0.008). A prolonged QTc syndrome was not uncommon in this cohort of asymptomatic HIV-infected patients with good immunovirological control. It was associated with hyperlipidemia and diastolic dysfunction. The use of atazanavir, compared with other protease inhibitors, was associated with a lower likelihood of having a prolonged QTc.

Prolonged QTc in HIV-Infected Patients: A Need for Routine ECG Screening

“…10 In another study of 194 outpatients where 92.4% had undetectable viral load and a mean CD4 count of 553 cells/ɥL, neither viral load or CD4 count was associated with prolonged QT. 8 The lack of association of CD4 or viral load with QTc prolongation in our study may reflect relatively well controlled HIV in this cohort, with high CD4 counts and the majority of patients having undetectable viral load, coupled with low statistical power.…”

QT prolongation in HIV-positive patients: Review article

“…It was observed that the likelihood of QT prolongation was lower in patients treated with ATZ as compared to those treated with other PIs. 41 Results of this study concur with the results presented by the previous research studies.…”

Initiation of antiretroviral therapy at high CD4 cell counts

“…The FDA warns that ritonovir boosted lopinavir(97) and saquinavir(98, 99) may be associated with prolongation of the QT interval and elevated risk of polymorphic ventricular tachycardia; however, PI use had minimal effect on the QT interval in SMART after adjusting for race(100). Atazanavir has been associated with a lower risk of QT prolongation, adding further evidence of its favorable CVD risk profile(101). It also appears that PIs as a class may be associated with pathologic prolongation of the PR interval(100).…”