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Cellular Redox Profiling Using High-content Microscopy
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Protease inhibitor-associated QT interval prolongation.

Kimberley Hunt1, Christine A Hughes, Cara Hills-Nieminen

  • 1Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.

The Annals of Pharmacotherapy
|December 1, 2011
PubMed
Summary

Protease inhibitors (PIs) do not appear to independently cause QT interval prolongation in HIV patients. However, other risk factors can increase this risk, suggesting monitoring may be considered for high-risk individuals.

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Published on: April 9, 2014

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Protease inhibitors (PIs) are crucial in managing HIV infection.
  • Concerns exist regarding their potential to prolong the QT interval and increase the risk of torsade de pointes.

Purpose of the Study:

  • To review and synthesize existing literature on the association between protease inhibitors and QT interval prolongation in HIV-infected patients.
  • To evaluate the risk of torsade de pointes associated with PI use.

Main Methods:

  • Comprehensive literature search of MEDLINE and EMBASE databases (1950-2011).
  • Inclusion of English-language case reports, volunteer studies, and studies in HIV-infected patients.
  • Review of article bibliographies and conference abstracts.

Main Results:

  • In vitro data and case reports suggest PIs may prolong the QT interval.
  • Saquinavir boosted with ritonavir was linked to QT prolongation in healthy volunteers.
  • Larger prospective studies did not confirm a significant QT prolongation risk with PIs in HIV patients.
  • Identified risk factors for QT prolongation in HIV patients mirror those in the general population (age, sex, comorbidities, other medications).

Conclusions:

  • Protease inhibitors do not seem to independently cause QT interval prolongation.
  • Concomitant risk factors, both HIV-related and non-HIV-related, are significant.
  • Routine ECG monitoring may not be necessary but can be considered for patients on multiple proarrhythmic medications or with comorbidities.