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

Abstract

Background: With patients infected with HIV living longer, there is an increased burden of comorbidities related to aging, HIV itself and polypharmacy. Cardiac morbidity is of particular importance. Methods: This two-group comparison study (156 HIV-positive and 105 HIV-negative patients) investigated the prevalence of abnormalities in and factors associated with an electrocardiogram (ECG) measure, corrected QT interval (QTc), where prolongation can lead to arrhythmia and sudden death. Medications prescribed (antiretroviral therapy (ART), psychiatric medications, methadone, and antibiotics) at the time of ECG were noted. Patient characteristics, medications, QTc and ECG characteristics were compared between two groups. Results: Prolongation (29% vs. 19%) and extreme prolongation (6% vs. 1%) in QTc were more frequent in those with HIV. ART was associated with lower odds of prolonged QTc (OR=0.35; p=0.04), while methadone with higher odds (OR=4.6; p=0.01) in HIV-positive patients. With methadone and medication groups adjusted, HIV status was still associated with 17 msec longer QTc (p=0.04). Conclusion: This study provides evidence that patients with HIV may have clinically relevant longer QTc interval on ECG. Baseline and routine ECG monitoring may be warranted among patients living with HIV in clinical practice based on cumulative evidence.

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

“…Prolongation of the QTc among PWH was posited to explain the greater risk of sudden cardiac death in this population. 6,18,19,42 There is wide variability in the reported prevalence of QTc prolongation among PWH (9%-12%) driven partly by variation in study design and inclusion criteria and whether sex-specific definitions of prolonged QTc were used. 24,28,[43][44][45] Using a cutoff of .440 milliseconds irrespective of sex, studies reported a prevalence between 9% and 12%.…”

Polypharmacy in HIV: recent insights and future directions

“…In addition to routine monitoring of organ system function and HIV biomarkers, there is growing awareness of the importance of corrected QT (QTc) monitoring given the effects of the non-nucleoside reverse transcriptase inhibitors, efavirenz and rilpivirine (9), which may interact with commonly prescribed medications (e.g., antibiotics, antipsychotics). PWH were more likely than uninfected patients to have evidence of QTc prolongation on electrocardiogram review; 29% of PWH demonstrated evidence of QTc prolongation and 6% with extreme prolongation, a finding that was driven at least in part by interactions with methadone (47). Importantly, drug-drug interactions may result in a "prescribing cascade" whereby additional medications are used to treat symptoms driven by drug-drug interactions, further exacerbating polypharmacy (16).…”

Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic

“… 12 Specific viruses are also associated with QTc prolongation. 13 , 14 , 15 Few analyses have compared QTc intervals between patients with and without COVID-19, an inflammatory viral condition. The present study used multivariable models to investigate which clinical characteristics were associated with prolonged QTc from baseline in patients with COVID-19 and to isolate the independent association of COVID-19 infection with QTc.…”