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Prolonged QTc in HIV-Infected Patients: A Need for Routine ECG Screening
Merle Myerson1, Emma Kaplan-Lewis2, Eduard Poltavskiy3,4
11 Cardiovascular Service Line and Research Institute, Bassett Medical Center, Cooperstown, NY, USA.
Insights
Patients with HIV have a higher risk of prolonged corrected QT interval (QTc), a measure on electrocardiograms (ECG) linked to sudden death. Antiretroviral therapy may reduce this risk, while methadone increases it, suggesting routine ECG monitoring for HIV patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Aging HIV patients face increased comorbidities, including cardiac issues.
- Polypharmacy and HIV itself contribute to cardiac morbidity.
- Electrocardiogram (ECG) abnormalities, specifically corrected QT interval (QTc) prolongation, are a concern.
Purpose of the Study:
- To compare the prevalence of QTc abnormalities between HIV-positive and HIV-negative individuals.
- To identify factors associated with QTc prolongation in patients with HIV.
- To assess the impact of medications, including antiretroviral therapy and methadone, on QTc interval.
Main Methods:
- A 2-group comparison study involving 156 HIV-positive and 105 HIV-negative patients.
- Electrocardiograms (ECGs) were used to measure the corrected QT interval (QTc).
- Medications such as antiretroviral therapy, psychiatric drugs, methadone, and antibiotics were recorded.
Main Results:
- Higher rates of QTc prolongation (29% vs. 19%) and extreme prolongation (6% vs. 1%) were observed in HIV-positive patients.
- Antiretroviral therapy was linked to lower odds of QTc prolongation (OR=0.35, P=0.04).
- Methadone use was associated with higher odds of QTc prolongation (OR=4.6, P=0.01), and HIV status independently predicted a longer QTc interval (17ms, P=0.04).
Conclusions:
- HIV-positive patients exhibit clinically significant longer QTc intervals on ECG.
- Routine ECG monitoring, including QTc assessment, may be beneficial for patients living with HIV.
- Understanding medication effects on QTc is crucial for managing cardiac risk in HIV care.
Background:
With HIV-infected patients living longer, there is an increased burden of comorbidities related to aging, HIV itself, and polypharmacy. Cardiac morbidity is of particular importance.
Methods:
This 2-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, psychiatric medications, methadone, and antibiotics) at the time of ECG were noted. Patient characteristics, medications, QTc, and ECG characteristics were compared between the 2 groups.
Results:
Prolongation (29% versus 19%) and extreme prolongation (6% versus 1%) in QTc were more frequent in those with HIV. Antiretroviral therapy was associated with lower odds of prolonged QTc (odds ratio [OR] = 0.35; P = .04), while methadone with higher odds (OR = 4.6; P = .01) in HIV-positive patients. With methadone and medication groups adjusted, HIV status was still associated with 17-millisecond longer QTc ( P = .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.
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