Role of antiretroviral treatment in prolonging QTc interval in HIV-positive patients

• Published in: Journal of Infection Vol. 54; no. 6; pp. 597 - 602
• Main Authors: Chinello, Pierangelo, Lisena, Francesco P., Angeletti, Claudio, Boumis, Evangelo, Papetti, Federica, Petrosillo, Nicola
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.06.2007; Elsevier BV; Elsevier
• Subjects: Aged; Alkynes; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Benzoxazines; Benzoxazines - administration & dosage; Benzoxazines - adverse effects; Biological and medical sciences; Case-Control Studies; Cyclopropanes; Efavirenz; Electrocardiography; Female; HIV; HIV Infections; HIV Infections - drug therapy; HIV Infections - physiopathology; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious Disease; Infectious diseases; Male; Medical sciences; Middle Aged; Nelfinavir; Nelfinavir - administration & dosage; Nelfinavir - adverse effects; Pharmacology. Drug treatments; QT interval; Reverse Transcriptase Inhibitors; Reverse Transcriptase Inhibitors - administration & dosage; Reverse Transcriptase Inhibitors - adverse effects; Risk Factors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Zidovudine; Zidovudine - administration & dosage; Zidovudine - adverse effects; QT interval; HIV; Efavirenz; Zidovudine; Nelfinavir; Sulfanilamide derivatives; Antiretroviral agent; Benzoxazine derivatives; RNA-directed DNA polymerase; Acetylenic compound; Arrhythmia; Non nucleoside compound; Trimethoprim; Cardiovascular disease; Opiates; Methadone; Narcotic analgesic; Antifolate; Electrodiagnosis; Sulfamethoxazole; Heart disease; Reverse transcriptase inhibitor; Electrocardiography; Nucleoside analog; Antiviral; Antiinfectious; Pyrimidine nucleoside; Immunopathology; Enzyme; Transferases; Enzyme inhibitor; AIDS; Immune deficiency; Infection; Allosteric inhibitor; Peptidases; Nucleotidyltransferases; Treatment; Dideoxynucleoside; Viral disease; Hydrolases; Pyrimidine derivatives; Antibacterial agent; Protease inhibitor
• ISSN: 0163-4453; 1532-2742; 1532-2742
• DOI: 10.1016/j.jinf.2006.11.001

The aims of our study were to assess the prevalence of QTc prolongation in a group of HIV-infected individuals and to evaluate the associated risk factors. All the 650 HIV-infected patients followed up at our outpatient clinic underwent ECG recording. A “nested” case–control study was performed using as cases 64 HIV-infected patients with QTc >0.44 s and as controls (1:4) 256 HIV-positive subjects matched by gender and age with QTc interval ≤0.44 s. A prolonged QTc interval was found in 9.8% of HIV-positive individuals (64/650). In the nested case–control study, an increased risk of having a prolonged QTc interval was observed among patients taking nelfinavir, efavirenz, methadone, cotrimoxazole or an excessive amount of alcohol. When a zidovudine (AZT)-containing backbone was associated with nelfinavir-based or efavirenz-based antiretroviral therapy, the risk of having a prolonged QTc interval was about three times higher than in patients taking nelfinavir or efavirenz without AZT. Several drugs administered to HIV-infected patients may cause a QTc interval prolongation increasing the risk of serious arrhythmias. An ECG follow-up for the assessment of QTc seems to be advisable for HIV-infected patients receiving drugs with a QTc prolonging potential.