Current assessment of heart rate variability and QTc interval length in HIV/AIDS

McIntosh, Roger C.; Lobo, Judith D.; Hurwitz, Barry E.

doi:10.1097/coh.0000000000000408

Cited by 18 publications

(14 citation statements)

References 32 publications

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“…HIV and pathologic Q-waves were associated in univariable analyses, but this association was attenuated to borderline significance after adjusting for traditional risk factors, suggesting an adverse risk profile among PLWH 9,24 to contribute. PLWH have increased risk of heart failure and cardiomyopathies 12 , and studies of intraventricular conduction defects in PLWH have found QRS-duration to be associated with use of protease inhibitors 25 . We therefore hypothesized HIV infection to be associated with IV-block, but distribution of IV-blocks was similar in PLWH and controls and there was no association to specific cART regimens.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of prolonged QT interval and electrocardiographic abnormalities in persons living with HIV

Knudsen¹,

Kofoed

Gelpi

et al. 2019

Aids

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Abnormal electrocardiograms (ECG) are associated with increased risk of arrhythmias and sudden cardiac death. We aimed to investigate the prevalence and associated risk factors of prolonged QTc and major ECG abnormalities, in persons living with HIV (PLWH) and uninfected controls. DESIGN PLWH aged ≥40 were recruited from the Copenhagen comorbidity in HIV infection (COCOMO) study and matched on sex and age to uninfected controls from the Copenhagen General Population Study. METHODS ECGs were categorized according to Minnesota Code Manual of ECG Findings definition of major abnormalities. A QT interval corrected for heart rate (QTc) >440ms in males and >460ms in females was considered prolonged. Pathologic Q-waves were defined as presence of major Q-wave abnormalities. RESULTS ECGs were available for 745 PLWH and 2,977 controls. Prolonged QTc was prevalent in 9% of PLWH and 6% of controls, p=.052. Pathologic Q-waves were more common in PLWH (6%) than in controls (4%), p=.028. There was no difference in prevalence of major ECG abnormalities between PLWH and controls, p=.987. In adjusted analyses, HIV was associated with a 3.6ms[1.8-5.4] longer QTc interval, p<.001, and HIV was independently associated with prolonged QTc (adjusted odds ratio: 1.59 [1.14-2.19]), p=.005. HIV was borderline associated to pathologic Q-waves after adjusting, p=.051. CONCLUSION HIV was associated with higher odds ratio of prolonged QTc after adjustment for cardiovascular risk factors, but analyses were not adjusted for QT-prolonging medication. Although evidence indicated more pathologic Q-waves in PLWH, the risk seemed to be associated mainly with an adverse risk profile.

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Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of prolonged QT interval and electrocardiographic abnormalities in persons living with HIV

Knudsen¹,

Kofoed

Gelpi

et al. 2019

Aids

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“…Studies of ART-naïve HIV+ individuals from developing countries suggest an increased prevalence of QT prolongation compared with HIV− controls and support a significant direct HIV effect 12. Among persons on ART, prior studies suggest longer QT intervals in those taking older PIs and NNRTIs 11.…”

Section: Discussionmentioning

confidence: 96%

Predictors of electrocardiographic QT interval prolongation in men with HIV

Zhang

Haberlen

et al. 2018

Heart

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ObjectiveHIV-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.MethodsWe 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.ResultsAfter 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.ConclusionsHIV+ 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.

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“…Electrocardiogram (ECG) was demonstrated to be another rational method to predict the cardiotoxicity of drugs 89 . Very recently, our group investigated the cardiac toxicity of 12 (Figure 5) by the ECG 29 .…”

Section: Safety Inspectionmentioning

confidence: 99%

Druggability modification strategies of the diarylpyrimidine‐type non‐nucleoside reverse transcriptase inhibitors

Zhuang

Chen

2021

Medicinal Research Reviews

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Drug discovery of human immunodeficiency virus (HIV) is a hot field in medicinal chemistry community for many years. The diarylpyrimidines (DAPYs) are the second‐generation non‐nucleoside reverse transcriptase inhibitors (NNRTIs) targeting reverse transcriptase, playing a great irreplaceable role in HIV transcriptional therapy. However, fast‐growing drug‐resistant mutations as nonnegligible challenge are still unpredictably appeared in the clinical practice, leading to deactivate or reduce the existing drugs. In the last 20 years, more and more novel DAPY derivatives have developed with the purpose to counter the mutants. Nevertheless, most of them have dissatisfactory pharmacokinetics (PK) or poor antiviral activity toward resistant mutant strains. In this article, we will analyze the NNRTI derivatives with promising druggability, and summarize a series of druggability modification strategies to improve the antiviral activity, reduce toxicity and improve the PK properties in recent years. The prospects of DAPYs and the directions for future efforts will be discussed.

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Current assessment of heart rate variability and QTc interval length in HIV/AIDS

Abstract: These emergent studies support the clinical relevance of the ECG across the age and HIV disease spectrum. Furthermore, the reported findings have implications for the management of cardiovascular and chronic inflammatory disease comorbidity in persons living with HIV.

Cited by 18 publications

References 32 publications

Prevalence and risk factors of prolonged QT interval and electrocardiographic abnormalities in persons living with HIV

Prevalence and risk factors of prolonged QT interval and electrocardiographic abnormalities in persons living with HIV

Predictors of electrocardiographic QT interval prolongation in men with HIV

Druggability modification strategies of the diarylpyrimidine‐type non‐nucleoside reverse transcriptase inhibitors

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