Myerson Merle, Kaplan-Lewis Emma, Poltavskiy Eduard, Ferris David, Bang Heejung
1 Cardiovascular Service Line and Research Institute, Bassett Medical Center, Cooperstown, NY, USA.
2 Department of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Int Assoc Provid AIDS Care. 2019 Jan-Dec;18:2325958219833926. doi: 10.1177/2325958219833926.
With HIV-infected patients living longer, there is an increased burden of comorbidities related to aging, HIV itself, and polypharmacy. Cardiac morbidity is of particular importance.
This 2-group comparison study (156 HIV-positive and 105 HIV-negative patients) investigated the prevalence of abnormalities in and factors associated with an electrocardiogram (ECG) measure, corrected QT interval (QTc), where prolongation can lead to arrhythmia and sudden death. Medications prescribed (antiretroviral therapy, psychiatric medications, methadone, and antibiotics) at the time of ECG were noted. Patient characteristics, medications, QTc, and ECG characteristics were compared between the 2 groups.
Prolongation (29% versus 19%) and extreme prolongation (6% versus 1%) in QTc were more frequent in those with HIV. Antiretroviral therapy was associated with lower odds of prolonged QTc (odds ratio [OR] = 0.35; P = .04), while methadone with higher odds (OR = 4.6; P = .01) in HIV-positive patients. With methadone and medication groups adjusted, HIV status was still associated with 17-millisecond longer QTc ( P = .04).
This study provides evidence that patients with HIV may have clinically relevant longer QTc interval on ECG. Baseline and routine ECG monitoring may be warranted among patients living with HIV in clinical practice based on cumulative evidence.
随着感染艾滋病毒的患者寿命延长，与衰老、艾滋病毒本身及多种药物治疗相关的合并症负担有所增加。心脏疾病尤为重要。
这项两组对比研究（156名艾滋病毒阳性患者和105名艾滋病毒阴性患者）调查了心电图测量指标校正QT间期（QTc）异常的患病率及相关因素，QTc延长可导致心律失常和猝死。记录心电图检查时所开的药物（抗逆转录病毒疗法、精神科药物、美沙酮和抗生素）。比较两组患者的特征、药物、QTc和心电图特征。
艾滋病毒感染者的QTc延长（29%对19%）和极度延长（6%对1%）更为常见。在艾滋病毒阳性患者中，抗逆转录病毒疗法与QTc延长几率较低相关（比值比[OR]=0.35；P=0.04），而美沙酮则与较高几率相关（OR=4.6；P=0.01）。在对美沙酮和药物组进行调整后，艾滋病毒感染状态仍与QTc延长17毫秒相关（P=0.04）。
本研究提供的证据表明，艾滋病毒感染者心电图上的QTc间期可能在临床上具有相关性地延长。基于累积证据，在临床实践中，对艾滋病毒感染者进行基线和常规心电图监测可能是必要的。
