Jing Liu1, Sumit K Shah2, Indranill Basu-Ray3, Julia Garcia-Diaz4, Kainat Khalid5, Mohammad Saeed6. 1. Baylor College of Medicine, Houston, TX, USA. Electronic address: Jing.Liu@bcm.edu. 2. University of Arkansas for Medical Sciences, Little Rock, AR, USA. Electronic address: sshah3@uams.edu. 3. Texas Heart Institute, Houston, TX, USA; St. Francis Hospital, Memphis, TN, USA. Electronic address: ibasuray@yahoo.com. 4. Ochsner Health System, New Orleans, LA, USA. Electronic address: jgarcia-diaz@ochsner.org. 5. University of Arkansas for Medical Sciences, Little Rock, AR, USA. Electronic address: Kainat.Khalid@bcm.edu. 6. University of Arkansas for Medical Sciences, Little Rock, AR, USA; Texas Heart Institute, Houston, TX, USA. Electronic address: mohammas@bcm.edu.
Abstract
INTRODUCTION: Antiretrovirals have immensely increased the average life expectancy of HIV-positive patients. However, the incidence of QT interval prolongation and other arrhythmias has also increased. METHODS: Pubmed and Google Scholar were searched for relevant literature published between 1990 and 2019. RESULTS AND DISCUSSION: HIV-positive patients with high viral load, low CD4 count, chronic inflammation, and autonomic neuropathy can develop QT interval prolongation. Another factor prolonging QT interval includes exposure to the HIV transactivator protein, which inhibits hERG K (+) channels controlling IKr K (+) currents in cardiomyocytes. Protease inhibitors inhibiting the CYP3A4 enzyme can also lead to QT interval prolongation. QT interval prolongation can potentially be exacerbated by opioids, antipsychotics, antibiotics, and antifungals, the adjunct medications often used in HIV-positive patients. Hepatic insufficiency in seropositive patients on antiretrovirals may also increase the risk of QT interval prolongation. CONCLUSION: Baseline and follow-up EKG in the susceptible population is suggested.
INTRODUCTION: Antiretrovirals have immensely increased the average life expectancy of HIV-positive patients. However, the incidence of QT interval prolongation and other arrhythmias has also increased. METHODS: Pubmed and Google Scholar were searched for relevant literature published between 1990 and 2019. RESULTS AND DISCUSSION: HIV-positive patients with high viral load, low CD4 count, chronic inflammation, and autonomic neuropathy can develop QT interval prolongation. Another factor prolonging QT interval includes exposure to the HIV transactivator protein, which inhibits hERG K (+) channels controlling IKr K (+) currents in cardiomyocytes. Protease inhibitors inhibiting the CYP3A4 enzyme can also lead to QT interval prolongation. QT interval prolongation can potentially be exacerbated by opioids, antipsychotics, antibiotics, and antifungals, the adjunct medications often used in HIV-positive patients. Hepatic insufficiency in seropositive patients on antiretrovirals may also increase the risk of QT interval prolongation. CONCLUSION: Baseline and follow-up EKG in the susceptible population is suggested.
Authors: Gerald S Bloomfield; Isabelle R Weir; Heather J Ribaudo; Kathleen V Fitch; Carl J Fichtenbaum; Laura E Moran; Roger Bedimo; Christopher de Filippi; Caryn G Morse; Jonathan Piccini; Markella V Zanni; Michael T Lu; Udo Hoffmann; Steven K Grinspoon; Pamela S Douglas Journal: J Acquir Immune Defic Syndr Date: 2022-03-01 Impact factor: 3.771
Authors: Sainikitha Prattipati; Francis M Sakita; Tumsifu G Tarimo; Godfrey L Kweka; Jerome J Mlangi; Amedeus V Maro; Lauren A Coaxum; Sophie W Galson; Alexander T Limkakeng; Anzibert Rugakingira; Sarah J Urasa; Nwora L Okeke; Blandina T Mmbaga; Gerald S Bloomfield; Julian T Hertz Journal: Glob Heart Date: 2022-06-10