Efavirenz-associated QT prolongation and Torsade de Pointes arrhythmia.
OBJECTIVE
To report a case of acquired long QT syndrome that, after exclusion of all other possible causes, was probably related to therapy with efavirenz, a novel nonnucleoside reverse transcriptase inhibitor.


METHODS
This patient presented with recurrent syncope and polymorphic ventricular tachycardia, which was treated with overdrive ventricular pacing and was eliminated by discontinuation of the offending drug.


CONCLUSIONS
This is the first reported case of QT prolongation and severe ventricular arrhythmia associated with the use of efavirenz. The temporal relationship between the initiation of treatment and the onset of electrocardiographic abnormalities, the absence of other apparent precipitating factors, as well as the normalization of QT interval and the resolution of the arrhythmia after discontinuation of the drug, strongly suggest a causal relationship between efavirenz and this adverse clinical event.


CONCLUSIONS
Our case shows that any new pharmaceutical compound introduced in clinical practice may potentially result in QT prolongation and life-threatening arrhythmia.
Castillo
Ricardo
R
Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.
Pedalino
Ronald P
RP
El-Sherif
Nabil
N
Turitto
Gioia
G
D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D048588:Benzoxazines; D002304:Cardiac Pacing, Artificial; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D010078:Oxazines / Q000009:adverse effects* / Q000627:therapeutic use; D013997:Time Factors; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000209:etiology / Q000628:therapy
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D010078:Oxazines; C098320:efavirenz