Frequency of QTc interval prolongation in HIV-infected adults from Paraguay in 2020

Authors

Raúl E. Real-Delor Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0002-5288-5854
Saul J.E. Brítez-Calderón Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0002-7937-5643
Vilma V. Carballo-Báez Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0002-8278-4499
Diana N. Cuevas-Machuca Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0001-5799-9650
Sandra A. Díaz-Fretes Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0002-0973-4671
María A. Escurra-Torres Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0001-6238-2487
Rodrigo D. Escurra-Torres Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0003-1132-6623
Diego M. García-Almirón Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0002-7914-6082
Elen M. González-Cantero Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0002-4019-8926
Jorge R. Halke-Saiz Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0003-2571-5697
Aurelio L. Larrea-Alarcón Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0002-7744-0595
Pamela N. Medina-Valdez Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0002-9184-9581
Keila N. Mendoza-Ayala Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0003-2223-795X
Andrés E. Orrego-Martínez Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0003-1673-5899
Jorge L. Ortiz-Martínez Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0001-6813-8637
Giovanni J. Pirelli-Cubas Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0002-2101-6955
María E. Tobal-Gómez Universidad Privada del Este, Facultad de Medicina, Asunción, Paraguay. https://orcid.org/0000-0003-0443-3527

DOI:

https://doi.org/10.35839/repis.5.3.935

Keywords:

long QT syndrome, electrocardiography, HIV, antiretrovirals

Abstract

Introduction: the prolonged QTc interval predisposes to serious arrhythmias. Various medications, including antiretrovirals, can prolong it. The objectives were to determine the demographic, clinical characteristics and the frequency of the prolonged QTc interval in patients with HIV. Methods: we conducted a prospective, observational study with a control group. Men and women, over 18 years of age, with HIV infection, who attended the National Hospital (Itauguá, Paraguay) during 2020, were included. Medical students acted as a control group. All subjects who did not give their consent and those with arrhythmias were excluded. Demographic, clinical, laboratory variables and 12-channel electrocardiogram at rest were measured. The study was approved by the Ethics Committee of the Universidad Privada del Este (Paraguay). Results: 39 HIV patients and 39 healthy controls entered the study. The mean age of the cases was 37 ± 11 years, being 59% male. The most frequent comorbidity in the cases was obesity (7.6%). The mean values of urea, creatinine, K, Ca and Mg in the cases were in the normal range. Prolonged QTc was detected in 18% of the cases and in 0% of the controls. The subjects with the electrocardiographic alteration were all on antiretroviral and multiple antibiotic treatment known to be associated with prolonged Qtc. Conclusion: the frequency of prolonged QTc in HIV patients was 18% and in healthy controls it was 0%. Regular monitoring of the electrocardiogram is recommended in HIV patients receiving drugs that prolong the QT interval.

Downloads

Download data is not yet available.

References

Márquez MF. El síndrome de QT largo: una breve revisión del diagnóstico electrocardiográfico incluyendo la prueba de Viskin. Arch Cardiol Mex. 2012;82(3):243–7. doi: 10.1016/j.acmx.2012.06.001

Dubner SJ, Moss AJ, Pérez Riera AR, Schapachnik E. El síndrome del intervalo QT prolongado desde el punto de vista de un cardiólogo. Rev Argent Cardiol. 2004;72(6):467–73. Disponible en: http://www.old2.sac.org.ar/wp-content/uploads/2014/04/507.pdf

Zaręba W. Drug induced QT prolongation. Cardiol J. 2007;14(6):523–33. Disponible en: https://journals.viamedica.pl/cardiology_journal/article/view/21648/17252

González-Melchor L, Villarreal-Molina T, Iturralde-Torres P, Medeiros-Domingo A. Muerte súbita cardiaca en el corazón estructuralmente normal: una actualización. Arch Cardiol México. 2014;84(4):293–304. doi: 10.1016/j.acmx.2014.04.002

Escárcega RO, Franco JJ, Mani BC, Vyas A, Tedaldi EM, Bove AA. Cardiovascular disease in patients with chronic human immunodeficiency virus infection. Int J Cardiol. 2014;175(1):1–7. doi: 10.1016/j.ijcard.2014.04.155

Ramalho D, Freitas J. Drug-induced life-threatening arrhythmias and sudden cardiac death: A clinical perspective of long QT, short QT and Brugada syndromes. Rev Port Cardiol. 2018;37(5):435–46. doi: 10.1016/j.repc.2017.07.010

Villamañán E, Armada E, Ruano M. Prolongación del intervalo QT inducido por fármacos: ¿conocemos sus riesgos? Med Clin. 2014;144(6):269–74. doi: 10.1016/j.medcli.2014.01.027

Höcht C, Opezzo JAW, Taira CA. Intervalo QT prolongado inducido por fármacos desde el punto de vista de un farmacólogo. Rev Argent Cardiol. 2004;72(6):474–80. Disponible en: http://www.old2.sac.org.ar/wp-content/uploads/2014/04/506.pdf

Vandael E, Vandenberk B, Vandenberghe J, Willems R, Foulon V. Risk factors for QTc-prolongation: systematic review of the evidence. Int J Clin Pharm. 2017;39(1):16–25. doi: 10.1007/s11096-016-0414-2

Woosley R, Heise C, Gallo T, Tate J, Woosley D, Romero K. QTdrugs List, AZCERT. Disponible en: https://www.crediblemeds.org/

Njoku PO, Ejim EC, Anisiuba BC, Ike SO, Onwubere BJC. Electrocardiographic findings in a cross-sectional study of human immunodeficiency virus (HIV) patients in Enugu, south-east Nigeria. Cardiovasc J Afr. 2016;27(4):252–7. doi: 10.5830/CVJA-2016-007

Aguilar G, Kawabata A, Samudio T, Ríos-González C. Comportamiento epidemiológico del VIH en Paraguay, 2017. Rev Salud Publica Parag. 2018;8(2):9–14. doi: 10.18004/rspp.2018.diciembre.9-14

Soliman EZ, Prineas RJ, Roediger MP, Duprez DA, Boccara F, Boesecke C, et al. Prevalence and prognostic significance of ECG abnormalities in HIV-infected patients: Results from the Strategies for Management of Antiretroviral Therapy study. J Electrocardiol. 2011;44(6):779–85. doi: 10.1016/j.jelectrocard.2010.10.027

Hernández-Pilotzi G, Huerta-Vargas D, Cerda-Téllez F, Martínez-Nava AG, Lozada-Pérez CA. Cambios electrocardiográficos en pacientes con VIH con y sin inhibidores de proteasa vs NNRTI. Med Interna Mex. 2018;34(2):204–13. doi: 10.24245/mim.v34i2.1831

Reinsch N, Arendt M, Geisel MH, Schulze C, Holzendorf V, Warnke A, et al. Prolongation of the QTc interval in HIV-infected individuals compared to the general population. Infection. 2017;45(5):659–67. doi: 10.1310/hct1004-261

Hunt K, Hughes CA, Hills-Nieminen C. Protease inhibitor-associated QT interval prolongation. Ann Pharmacother. 2011;45(12):1544–50. doi: 10.1345/aph.1Q422

Chinello P, Lisena FP, Angeletti C, Boumis E, Papetti F, Petrosillo N. Role of antiretroviral treatment in prolonging QTc interval in HIV-positive patients. J Infect. 2007;54(6):597–602. doi: 10.1016/j.jinf.2006.11.001

Wu KC, Zhang L, Haberlen SA, Ashikaga H, Brown TT, Budoff MJ, et al. Predictors of electrocardiographic QT interval prolongation in men with HIV. Heart. 2019;105(7):559–65. doi: 10.1136/heartjnl-2018-313667

Roy T, Giménez RP, Gamarra Cardozo L, Núñez Vera L, Santacruz Sosa M, Alarcón Maciel V, et al. Intervalo QTc prolongado en pacientes de Clínica Médica: estudio multicéntrico. Rev Virtual Soc Parag Med Int. 2020;7(1):0–2. doi: 10.18004/rvspmi/2312-3893/2020.07.01.10-019

Pham, TV, Torres M. Human immunodeficiency virus infection-related heart disease. Emerg Med Clin North Am. 2015;33(3):613–22. doi: 10.1016/j.emc.2015.04.009

Ogunmodede J, Kolo P, Katibi I, Omotoso A. The use of first line highly active anti-retroviral therapy (HAART) is not associated with QTc prolongation in HIV patients. Ethiop J Heal Sci. 2017;27(6):613–20. doi: 10.4314/ejhs.v27i6.6

Currier JS, Havlir D V. CROI 2018: Complications of HIV infection and antiretroviral therapy. Top Antivir Med. 2018;26(1):22–9. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963934/pdf/tam-26-022.pdf

Liu J, Shah SK, Basu-Ray I, Garcia-Diaz J, Khalid K, Saeed M. QT prolongation in HIV-positive patients: Review article. Indian Heart J. 2019;71(6):434–9. doi: 10.1016/j.ihj.2019.11.259

Roden DM. Predicting drug-induced QT prolongation and torsades de pointes. J Physiol. 2016;594(9):2459–68. doi: 10.1113/JP270526

Puri R, Roberts-Thomson KC, Young GD. HIV and long QT syndrome-cause or coincidence. Int J Cardiol. 2009;133(1):e9–10. doi: 10.1016/j.ijcard.2007.08.076

Fiorentini A, Petrosillo N, Di Stefano A, Cicalini S, Borgognoni L, Boumis E, et al. QTc interval prolongation in HIV-infected patients: A case-control study by 24-hour Holter ECG recording. BMC Cardiovasc Disord. 2012;12:124. doi: 10.1186/1471-2261-12-124

Demir OM, Candilio L, Fuster D, Muga R, Barbaro G, Colombo A, et al. Cardiovascular disease burden among human immunodeficiency virus-infected individuals. Int J Cardiol. 2018;265:195–203. doi: 10.1016/j.ijcard.2018.03.137

Dhama K, Khan S, Tiwari R, Sircar S, Bhat S, Malik YS, et al. Coronavirus Disease 2019–COVID-19. Clin Microbiol Rev. 2020;33(4):e00028-20.doi: 10.1128/CMR.00028-20

Tisdale JE. Drug-induced QT interval prolongation and torsades de pointes: Role of the pharmacist in risk assessment, prevention and management. Can Pharm J. 2016;149(3):139–52. doi: 10.1177/1715163516641136

Fernandes FM, Silva EP, Martins RR, Oliveira AG. QTc interval prolongation in critically ill patients: Prevalence, risk factors and associated medications. PLoS One. 2018;13(6):e0199028. doi: 10.1371/journal.pone.0199028