Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Heart. 2019 Apr;105(7):559-565. doi: 10.1136/heartjnl-2018-313667. Epub 2018 Oct 26.
HIV-infected (HIV+) individuals may be at increased risk for sudden arrhythmic cardiac death. Some studies have reported an association between HIV infection and prolongation of the electrocardiographic QT interval, a measure of ventricular repolarisation, which could potentiate ventricular arrhythmias. We aimed to assess whether HIV+ men have longer QT intervals than HIV-uninfected (HIV-) men and to determine factors associated with QT duration.
We performed resting 12-lead ECGs in 774 HIV+ and 652 HIV- men in the Multicenter AIDS Cohort Study (MACS). We used multivariable linear and logistic regression analyses to assess associations between HIV serostatus and Framingham corrected QT interval (QTc), after accounting for potential confounders. We also determined associations among QTc interval and HIV-related factors in HIV+ men. In a subgroup of participants, levels of serum markers of inflammation were also assessed.
After adjusting for demographics and risk factors, QTc was 4.0 ms longer in HIV+ than HIV- men (p<0.001). Use of antiretroviral therapy (ART), specific ART drug class use and other HIV-specific risk factors were not associated with longer QTc. Among the subgroup with inflammatory biomarker measurements, higher interleukin-6 (IL-6), intercellular adhesion molecule-1 (ICAM-1) and B-cell activating factor levels were independently associated with longer QTc and their inclusion partially attenuated the HIV effect.
HIV+ men had longer QTc, which was associated with higher levels of systemic inflammatory factors. This longer QTc may contribute to the increased risk for sudden arrhythmic cardiac death in some HIV+ individuals.
感染 HIV（HIV+）的个体可能有更高的风险发生心律失常性心源性猝死。一些研究报告称 HIV 感染与心电图 QT 间期延长有关，QT 间期是心室复极的测量指标，可能导致室性心律失常。我们旨在评估 HIV+男性的 QT 间期是否长于未感染 HIV（HIV-）的男性，并确定与 QT 持续时间相关的因素。
我们对多中心 AIDS 队列研究（MACS）中的 774 名 HIV+和 652 名 HIV-男性进行了静息 12 导联心电图检查。我们使用多变量线性和逻辑回归分析，在考虑潜在混杂因素后，评估 HIV 血清状态与 Framingham 校正 QT 间期（QTc）之间的关系。我们还确定了 HIV+男性的 QTc 间隔与 HIV 相关因素之间的关系。在一部分参与者中，还评估了血清炎症标志物的水平。
在调整了人口统计学和危险因素后，HIV+男性的 QTc 比 HIV-男性长 4.0 毫秒（p<0.001）。使用抗逆转录病毒疗法（ART）、特定的 ART 药物类别使用和其他 HIV 特异性危险因素与更长的 QTc 无关。在具有炎症生物标志物测量的亚组中，较高的白细胞介素 6（IL-6）、细胞间黏附分子 1（ICAM-1）和 B 细胞激活因子水平与更长的 QTc 独立相关，它们的纳入部分减轻了 HIV 的影响。
HIV+男性的 QTc 较长，与更高水平的全身炎症因子有关。这种更长的 QTc 可能导致一些 HIV+个体心律失常性心源性猝死的风险增加。
