Viral Load and CD4+ Cell Count as Risk Factors for Prolonged QT Interval in HIV-Infected Subjects: A Cohort-Nested Case-Control Study in an Outpatient Population

Abstract

Background: QTc interval prolongation is a serious ECG finding which has frequently been reported in HIV-infected patients, but associated risk factors have not been determined in this population. Methods: Data were collected from the charts of a cohort of 135 consecutive HIV-infected patients from our HIV outpatient clinic. The cohort was divided into two groups, patients with prolonged QTc and those with normal QTc interval. Multiple variables and potential risk factors were analyzed, including the CD4+ cell count and viral load (VL), which were assessed on the same day or within several days of the initial ECG. Results: 23 patients were found to have prolonged QTc (17%). No significant difference in baseline characteristics was observed between the groups; however, statistically significant differences were observed with regard to the CD4+ cell count and VL. Conclusion: A low CD4 cell count and a high VL may be risk factors potentially related to QT prolongation in HIV patients in the outpatient setting.

Drug-Induced Long QT in Adult Psychiatric Inpatients: The 5-Year Cross-Sectional ECG Screening Outcome in Psychiatry Study

“…In HIV-infected individuals, high viral load and low CD4+ cell count (cutoff values, 17,900 copies/mL and 144 cells/ mm 3 , respectively) were associated with QT lengthening (21). Autonomic neuropathy was reported as a possible explanation (22).…”

QT prolongation in HIV-positive patients: Review article

“…Prevalence of QT interval prolongation is higher in patients with higher HIV viral load and lower CD4 cell count. 13 A cross-sectional cohort study involving 802 HIV-positive patients was conducted to identify the association between HIV seropositivity and QT interval prolongation. It was observed that HIV-positive patients exhibited a 20% higher prevalence of prolonged QT interval as compared to the HIV-negative population (12).…”

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

“…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.…”

“…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.…”