Role of antiretroviral treatment in prolonging QTc interval in HIV-positive patients.
OBJECTIVE
The aims of our study were to assess the prevalence of QTc prolongation in a group of HIV-infected individuals and to evaluate the associated risk factors.


METHODS
All the 650 HIV-infected patients followed up at our outpatient clinic underwent ECG recording. A "nested" case-control study was performed using as cases 64 HIV-infected patients with QTc > 0.44 s and as controls (1:4) 256 HIV-positive subjects matched by gender and age with QTc interval < or = 0.44 s.


RESULTS
A prolonged QTc interval was found in 9.8% of HIV-positive individuals (64/650). In the nested case-control study, an increased risk of having a prolonged QTc interval was observed among patients taking nelfinavir, efavirenz, methadone, cotrimoxazole or an excessive amount of alcohol. When a zidovudine (AZT)-containing backbone was associated with nelfinavir-based or efavirenz-based antiretroviral therapy, the risk of having a prolonged QTc interval was about three times higher than in patients taking nelfinavir or efavirenz without AZT.


CONCLUSIONS
Several drugs administered to HIV-infected patients may cause a QTc interval prolongation increasing the risk of serious arrhythmias. An ECG follow-up for the assessment of QTc seems to be advisable for HIV-infected patients receiving drugs with a QTc prolonging potential.
Chinello
Pierangelo
P
Second Infectious Diseases Division, National Institute for Infectious Diseases L. Spallanzani, Via Portuense 292, 00149 Rome, Italy. chinellop@katamail.com <chinellop@katamail.com>
Lisena
Francesco P
FP
Angeletti
Claudio
C
Boumis
Evangelo
E
Papetti
Federica
F
Petrosillo
Nicola
N
D000368:Aged; D000480:Alkynes; D048588:Benzoxazines / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D003521:Cyclopropanes; D004562:Electrocardiography; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019888:Nelfinavir / Q000008:administration & dosage / Q000009:adverse effects; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D015215:Zidovudine / Q000008:administration & dosage / Q000009:adverse effects
D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine; D019888:Nelfinavir; C098320:efavirenz