A prospective evaluation of the effect of atazanavir on the QTc interval and QTc dispersion in HIV-positive patients.
BACKGROUND
Atazanavir (ATV), an HIV protease inhibitor (PI) that may be preferred for the treatment of HIV-infected patients with cardiovascular comorbidities because of its favourable effects on plasma lipids, has been associated with cardiac rhythm disturbances.


OBJECTIVE
To quantify the effect of ATV on corrected QT (QTc) and QTc dispersion (QTd), markers of the potential for cardiac dysrhythmia, in patients switching from other PIs to ATV.


METHODS
In this prospective, single-centre, open-label study, 12-lead electrocardiograms were performed for subjects at baseline, 2 h after the first dose of ATV, and 1 month after initiation of ATV.


RESULTS
Twenty-one patients (19 received ritonavir-boosted ATV) completed the study. There was a trend towards an increase in the QTc at 2 h after the first dose [mean+/-standard deviation 3.19+/-8.0 ms; 95% confidence interval (CI) -0.47 to 6.85 ms; P=0.084]. There was no difference between QTc values at baseline and at 1 month (-1.5+/-8.75 ms; 95% CI -5.50 to 2.46; P=0.43). There was a nonsignificant decrease in the QTd between baseline and 2 h (-5.1+/-15.19 ms; 95% CI -13.22 to 2.96; P=0.197) and between baseline and 1 month (-0.61+/-15.04 ms; 95% CI -8.1 to 6.87; P=0.865). A significant increase in the PR interval (7.4+/-10.7 ms; 95% CI 2.5 to 12.25 ms; P=0.005) was observed at 1 month.


CONCLUSIONS
The use of ATV did not result in increases in the QTc interval or QTd. However, PR interval monitoring may be warranted in patients with underlying heart block or those treated with atrioventricular nodal blocking agents.
Busti
A J
AJ
Texas Tech University Health Sciences Center School of Pharmacy, Dallas/Ft. Worth Regional Campus, Dallas, TX 75216, USA. anthony.busti@ttuhsc.edu
Tsikouris
J P
JP
Peeters
M J
MJ
Das
S R
SR
Canham
R M
RM
Abdullah
S M
SM
Margolis
D M
DM
D023241:Antiretroviral Therapy, Highly Active; D001145:Arrhythmias, Cardiac / Q000517:prevention & control*; D000069446:Atazanavir Sulfate; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D006329:Heart Conduction System / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000494:pharmacology* / Q000627:therapeutic use; D011446:Prospective Studies; D011725:Pyridines / Q000494:pharmacology* / Q000627:therapeutic use; D016896:Treatment Outcome
D017320:HIV Protease Inhibitors; D009842:Oligopeptides; D011725:Pyridines; D000069446:Atazanavir Sulfate