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

Knudsen, Andreas Dehlbæka,b; Kofoed, Klaus Fuglsangb,c; Gelpi, Marcoa; Sigvardsen, Per Ejlstrupb; Mocroft, Amandad; Kühl, Jørgen Tobiasb; Fuchs, Andreasb; Køber, Larsb; Nordestgaard, Børge G.e,f; Benfield, Thomasg; Graff, Claush; Skov, Morten Wagnerb; Lundgren, Jensi; Nielsen, Susanne Dama on behalf of the Copenhagen Comorbidity in HIV Infection (COCOMO) Study

doi: 10.1097/QAD.0000000000002327
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Objective: Abnormal ECGs 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 at least 40 years 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) greater than 440 ms in men and greater than 460 ms in women was considered prolonged. Pathologic Q-waves were defined as presence of major Q-wave abnormalities.

Results: ECGs were available for 745 PLWH and 2977 controls. Prolonged QTc was prevalent in 9% of PLWH and 6% of controls, P = 0.052. Pathologic Q-waves were more common in PLWH (6%) than in controls (4%), P = 0.028. There was no difference in prevalence of major ECG abnormalities between PLWH and controls, P = 0.987.

In adjusted analyses, HIV was associated with a 3.6 ms (1.8–5.4) longer QTc interval, P < 0.001, and HIV was independently associated with prolonged QTc [adjusted odds ratio: 1.59 (1.14–2.19)], P = 0.005. HIV was borderline associated to pathologic Q-waves after adjusting, P = 0.051.

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.

aDepartment of Infectious Diseases

bDepartment of Cardiology

cDepartment of Radiology, Rigshospitalt, University of Copenhagen, Copenhagen, Denmark

dInstitute for Global Health, UCL., Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), London, United Kingdom

eThe Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev

fFaculty of Health and Medical Sciences, University of Copenhagen

gDepartment of Infectious Diseases, Hvidovre Hospital, Copenhagen

hDepartment of Health Science and Technology, Aalborg University, Aalborg

iCHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Correspondence to Susanne Dam Nielsen, MD, DMSc, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. E-mail: sdn@dadlnet.dk

Received 20 March, 2019

Revised 12 June, 2019

Accepted 16 June, 2019

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