Prolongation of the QTc interval in HIV-infected individuals compared to the general population
- 274 Downloads
Prolonged QT interval is associated with arrhythmias and sudden death. An increased prevalence of QT interval prolongation in human immunodeficiency virus-infected (HIV) subjects was previously described. The impact of different medications and HIV infection itself on the QT interval is rarely investigated in large HIV+ cohorts.
We compared QT interval measurement in 496 HIV(+) patients of the HIV-HEART study (HIVH) and 992 sex- and age-matched controls of the population-based German Heinz Nixdorf Recall study (HNR). QT corrected for heart rate (QTc) >440 ms in male and >460 ms in female was considered pathological. We analysed the impact of HIV status and HIV medication on QTc prolongation in the HIVH subjects.
We observed longer QTc in HIVH subjects compared with HNR controls: 424.1 ms ± 23.3 vs. 411.3 ± 15.3 ms for male and 435.5 ms ± 19.6 vs. 416.4 ms ± 17.3 for female subjects (p < 0.0001 for both sexes). Adjusting for QT prolonging medication the mean differences in QTc between the two studies remained significant with 12.6 ms (95% CI 10.5–14.8; p value <0.0001) for male and 19.3 ms (95% CI 14.5–24.2; p value <0.0001) for female subjects. Prolongation of QTc was pathologic in 22.8 vs. 3.9% of HIV(+) and non-infected males and in 12.1 vs. 1.8% of the females [OR of 7.9 (5.0–12.6) and OR of 6.7 (1.8–24.2), respectively]. Smoking behaviour was an independent factor to lengthen QTc in HIV(+) patients. Diabetes mellitus was not a risk factor itself, but might be associated with medication which was associated with LQT. We could not observe any influence of the HIV status, ART, or any co-medication on the QTc.
Our study showed that HIV(+) patients had significantly longer QTc intervals compared to the general population. The number of patients with pathologic QTc prolongation was significantly increased in HIV(+) population.
KeywordsQTc prolongation HIV Electrocardiogram ART
The authors give their respect and thanks to all participating and supporting persons of the present study, including the staff of the recruiting centers, i.e. the team of Dr. Hower (Dortmund).
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 10.Neumann T, Esser S, Potthoff A, Pankuweit S, Neumann A, Breuckmann F, Neuhaus K, Kondratieva J, Buck T, Muller-Tasch T, Wachter R, Prettin C, Gelbrich G, Herzog W, Pieske B, Rauchhaus M, Loffler M, Maisch B, Mugge A, Wasem J, Gerken G, Brockmeyer NH, Erbel R. Prevalence and natural history of heart failure in outpatient HIV-infected subjects: rationale and design of the HIV-HEART study. Eur J Med Res. 2007;12:243–8.PubMedGoogle Scholar
- 11.Schmermund A, Mohlenkamp S, Stang A, Gronemeyer D, Seibel R, Hirche H, Mann K, Siffert W, Lauterbach K, Siegrist J, Jockel KH, Erbel R. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study. Risk factors, evaluation of coronary calcium and lifestyle. Am Heart J. 2002;144:212–8.CrossRefPubMedGoogle Scholar
- 16.Zareba W, Moss AJ, Schwartz PJ, Vincent GM, Robinson JL, Priori SG, Benhorin J, Locati EH, Towbin JA, Keating MT, Lehmann MH, Hall WJ. Influence of genotype on the clinical course of the long-QT syndrome. International Long-QT Syndrome Registry Research Group. N Engl J Med. 1998;339:960–5.CrossRefPubMedGoogle Scholar
- 18.Mohlenkamp S, Schmermund A, Lehmann N, Roggenbuck U, Dragano N, Stang A, Moebus S, Beck EM, Schluter C, Sack S, Meinertz T, Taylor A, Jockel KH, Erbel R. Subclinical coronary atherosclerosis and resting ECG abnormalities in an unselected general population. Atherosclerosis. 2008;196:786–94.CrossRefPubMedGoogle Scholar
- 24.Hrovatin E, Zardo F, Brieda M, Dametto E, Piazza R, Antonini-Canterin F, Cassin M, Meneguzzo N, Viel E, Lestuzzi C, Di Gennaro G, Nicolosi GL. Long QT and torsade de pointes in a patient with acquired human immunodeficiency virus infection in multitherapy with drugs affecting cytochrome P450. Ital Heart J Suppl. 2004;5:735–40.PubMedGoogle Scholar
- 28.Soliman EZ, Lundgren JD, Roediger MP, Duprez DA, Temesgen Z, Bickel M, Shlay JC, Somboonwit C, Reiss P, Stein JH, Neaton JD, INSIGHT SMART Study Group. Boosted protease inhibitors and the electrocardiographic measures of QT and PR durations. AIDS. 2011;25:367–77.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Gili S, Mancone M, Ballocca F, Grosso Marra W, Calcagno A, D’Ettorre G, Cannillo M, D’Ascenzo F, Orofino G, Marruncheddu L, Lonni E, Cinque A, Vullo F, Ceccarelli G, Vilardi I, Sardella G, Vullo V, Moretti C, Fedele F, Bonora S, Gaita F. Prevalence and predictors of long corrected QT interval in HIV-positive patients: a multicenter study. J Cardiovasc Med (Hagerstown). 2017;18:539–44.CrossRefGoogle Scholar
- 35.Lehmann MH, Timothy KW, Frankovich D, Fromm BS, Keating M, Locati EH, Taggart RT, Towbin JA, Moss AJ, Schwartz PJ, Vincent GM. Age-gender influence on the rate-corrected QT interval and the QT-heart rate relation in families with genotypically characterized long QT syndrome. J Am Coll Cardiol. 1997;29:93–9.CrossRefPubMedGoogle Scholar
- 36.Locati EH, Zareba W, Moss AJ, Schwartz PJ, Vincent GM, Lehmann MH, Towbin JA, Priori SG, Napolitano C, Robinson JL, Andrews M, Timothy K, Hall WJ. Age- and sex-related differences in clinical manifestations in patients with congenital long-QT syndrome: findings from the International LQTS Registry. Circulation. 1998;97:2237–44.CrossRefPubMedGoogle Scholar