Predictors of electrocardiographic QT interval prolongation in men with HIV (original) (raw)

Original research article

Predictors of electrocardiographic QT interval prolongation in men with HIV

http://orcid.org/0000-0003-4958-5145Katherine C Wu1,
Long Zhang2,
Sabina A Haberlen2,
http://orcid.org/0000-0003-3689-6892Hiroshi Ashikaga1,
Todd T Brown3,
http://orcid.org/0000-0002-9616-1946Matthew J Budoff4,
Gypsyamber D’Souza2,
Lawrence A Kingsley5,
Frank J Palella6,
Joseph B Margolick7,
Otoniel Martínez-Maza8,9,
Elsayed Z Soliman10,11,
Wendy S Post1,2
1 Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
2 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
3 Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
4 Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California, USA
5 Departments of Infectious Diseases and Microbiology and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
6 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
7 Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
8 Department of Obstetrics and Gynecology, Microbiology, Immunology & Molecular Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
9 Department of Epidemiology, UCLA Fielding School of Public Health, and UCLA AIDS Institute, Los Angeles, California, USA
10 Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Winston-Salem, North Carolina, USA
11 Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
Correspondence to Dr Katherine C Wu, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA; kwu{at}jhmi.edu

Abstract

Objective HIV-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.

Methods We 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.

Results After 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.

Conclusions HIV+ 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.

electrocardiography
cardiac risk factors and prevention
inflammatory markers

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