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Prevalence and predictors of long corrected QT interval in HIV-positive patients: a multicenter study
Sebastiano Gili1, Massimo Mancone, Flavia Ballocca
1aDivision of Cardiology, Department of Medical Sciences, Città Della Salute e della Scienza Hospital, University of Turin, Turin bDepartment of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, "Sapienza" University of Rome, Policlinico "Umberto" I, Rome, Italy cDepartment of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Policlinico 'Umberto I', Rome dDivision of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy.
Insights
A low CD4+ cell count is a key predictor of prolonged corrected QT interval (cQT) in HIV-positive patients. This finding is independent of highly active antiretroviral therapy (HAART) and helps stratify arrhythmic risk.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- HIV infection and HAART can impact cardiac conduction, increasing sudden death risk.
- Predictors of prolonged corrected QT interval (cQT) in HIV patients are not well-defined.
- Understanding cQT prolongation is crucial for managing cardiac risk in this population.
Purpose of the Study:
- To determine the prevalence of prolonged cQT in HIV-positive patients.
- To identify predictors of cQT prolongation in this cohort.
- To explore the association between HAART, HIV-related factors, and long cQT.
Main Methods:
- Retrospective enrollment of HIV-positive patients from two Italian clinics.
- 12-lead ECGs and clinical data collection.
- Definition of long cQT: >470 ms (women), >450 ms (men).
Main Results:
- 26 out of 351 (7.4%) patients had prolonged cQT.
- Long cQT was associated with higher age and lower CD4+ counts.
- Nadir CD4+ cell count below 200 cells/μl was the strongest predictor (OR 5.8).
Conclusions:
- Low CD4+ cell count is independently associated with long cQT in HIV patients.
- This association is independent of HAART.
- CD4+ nadir is a valuable marker for stratifying arrhythmic risk in HIV-positive individuals.
Aims:
HIV and highly active antiretroviral therapy (HAART) may affect cardiac conduction, and a higher incidence of sudden death has been recognized in HIV-positive patients. Nevertheless, predictors of prolonged corrected QT interval (cQT) have been poorly described. The aim of the study was to investigate the prevalence and predictors of long cQT in a cohort of HIV-positive patients.
Methods:
Consecutive HIV-positive patients followed in a primary prevention clinic at two Italian institutions were retrospectively enrolled. A 12-lead ECG was recorded in all patients; main clinical features were collected. Prevalence of long cQT (defined as cQT >470 ms in women and >450 ms in men) was the primary end-point. Secondary end-points were the identification of predictors of cQT prolongation, and the association between HAART and HIV-related features with long cQT.
Results:
Three hundred and fifty-one HIV-positive patients were included, 26 (7.4%) with long cQT. Mean age was higher among those with long cQT (51.6 vs. 57.6 years; P = 0.007). A higher prevalence of long cQT was reported for patients with a CD4+ cell count below 200 cells/μl at the moment of ECG (60 vs. 24.2%; P = 0.002) and with a nadir of CD4+ cell count below 200 cells/μl (91.3 vs. 58.6%; P = 0.001). At multivariate analysis, only the nadir of CD4+ cell count below 200 cells/μl consistently related to the presence of long cQT (odds ratio 5.8, 95% confidence interval 1.3-26.4).
Conclusion:
A low CD4+ cell count is associated with long cQT independently from HAART in HIV-positive patients and may be useful to correctly stratify arrhythmic risk in these patients.
