The effect of antiretroviral therapy on the frequency and severity of cardiac arrhythmias in HIV-infected patients
DOI:
https://doi.org/10.14739/2310-1210.2019.6.186465Keywords:
HIV-infection, antiretroviral therapy, ambulatory monitoring ECG, atrial premature complexes, heart rhythm variability, C-reactive proteinAbstract
The aim to study the effects of ART on the incidence and severity of supraventricular ectopy (SVE) and ventricular ectopy (VE) in HIV-infected patients.
Materials and methods. We analyzed the results of ambulatory monitoring ECG (AM ECG) in 43 HIV-infected patients before and after antiretroviral therapy (ART). The amount of serum high sensitivity C-reactive protein (hsCRP) was determined in all patients.
Results. In all patients before prescribing ART and one year after ART, SVE was registered with varying severity, whereas SVE was registered in 28 (93.3 %) patients of the control group. VE was detected in 31 (72.1 %) patients before prescribing ART, 27 (62.5 %) patients after a year of receiving ART and 6 (20 %) patients in the control group. After analyzing the structure of SVE and VE, it was noted that in HIV-infected patients before ART, a greater number of SVE and VE was recorded, which were significantly decreased when the virological and immunological goals of ART were achieved. Patients showed an increase in the SDNN index to 148.3 ± 11.2 ms and SDANN to 133.3 ± 8.3 ms after effective ART. There were not significant changes in other time-domain heart rhythm variability (HRV) indicators (SDNN, SDNN-index, pNN50 and rMSSD) in this group. A decrease in the frequency and severity of SVE and VE as well as HRV profile improvement were registered with a decrease in the concentration of highly sensitive CRP from 19.1 ± 2.2 mg/l to 10.7 ± 1.3 mg/l (P ˂ 0.05).
Conclusions. In HIV-infected patients, both supraventricular and ventricular ectopy are more pronounced and significantly more frequently recorded, including ectopic rhythms which are not peculiar to healthy people. In HIV-infected patients on antiretroviral therapy for 52 ± 4 weeks when viral load <20 copies/ml and CD4 + T lymphocytes >400 cells/ml are reached, the frequency of supraventricular and ventricular ectopy registration is significantly decreased. In HIV-infected patients, a decrease in supraventricular ectopy and ventricular ectopy intensity occurs coupled with a decrease in the level of hsCRP, as well as an improvement in the integral time and spectral indices of heart rate variability. This suggests that systemic inflammatory response and hypersympathicotonia are pathogenetic links of arrhythmogenesis in HIV-infected patients.
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