HIV 阳性患者的 QT 间期延长：综述文章。
QT prolongation in HIV-positive patients: Review article.
作者信息
Liu Jing, Shah Sumit K, Basu-Ray Indranill, Garcia-Diaz Julia, Khalid Kainat, Saeed Mohammad
机构信息
Baylor College of Medicine, Houston, TX, USA.
University of Arkansas for Medical Sciences, Little Rock, AR, USA.
出版信息
Indian Heart J. 2019 Nov-Dec;71(6):434-439. doi: 10.1016/j.ihj.2019.11.259. Epub 2019 Dec 3.
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.
引言
抗逆转录病毒药物极大地提高了HIV阳性患者的平均预期寿命。然而，QT间期延长和其他心律失常的发生率也有所增加。
方法
检索了1990年至2019年期间发表在PubMed和谷歌学术上的相关文献。
结果与讨论
病毒载量高、CD4计数低、慢性炎症和自主神经病变的HIV阳性患者可出现QT间期延长。另一个延长QT间期的因素包括接触HIV反式激活蛋白，该蛋白抑制控制心肌细胞IKr K(+)电流的hERG K(+)通道。抑制CYP3A4酶的蛋白酶抑制剂也可导致QT间期延长。QT间期延长可能会因阿片类药物、抗精神病药物、抗生素和抗真菌药物（这些常用于HIV阳性患者的辅助药物）而加重。接受抗逆转录病毒治疗的血清反应阳性患者的肝功能不全也可能增加QT间期延长的风险。
结论
建议对易感人群进行基线和随访心电图检查。
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