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.
References
Coplan, P., Nikas, A., Japour, A., Cormier, K., Maradit-Kremers, H., & Lewis, R. et al. (2003). Incidence of myocardial infarction in randomized clinical trials of protease inhibitor-based antiretroviral therapy: an analysis of four different protease inhibitors. AIDS Research And Human Retroviruses, 19(6), 449-455. doi: 10.1089/088922203766774487
Chinello, P., Lisena, F., Angeletti, C., Boumis, E., Papetti, F., & Petrosillo, N. (2007). Role of antiretroviral treatment in prolonging QTc interval in HIV-positive patients. Journal Of Infection, 54(6), 597-602. doi: 10.1016/j.jinf.2006.11.001
Hsu, J., Li, Y., Marcus, G., Hsue, P., Scherzer, R., Grunfeld, C., & Shlipak, M. (2013). Atrial Fibrillation and Atrial Flutter in Human Immunodeficiency Virus-Infected Persons. Journal Of The American College Of Cardiology, 61(22), 2288-2295. doi: 10.1016/j.jacc.2013.03.022
Lang, S., Mary-Krause, M., Cotte, L., Gilquin, J., Partisani, M., & Simon, A. et al. (2010). Increased risk of myocardial infarction in HIV-infected patients in France, relative to the general population. AIDS, 24(8), 1228-1230. doi: 10.1097/qad.0b013e328339192f
Singh, M., Arora, R., & Jawad, E. (2010). HIV Protease Inhibitors Induced Prolongation of the QT Interval: Electrophysiology and Clinical Implications. American Journal Of Therapeutics, 17(6), e193-201. doi: 10.1097/mjt.0b013e3181ad3437
Soliman, E., Prineas, R., Roediger, M., Duprez, D., Boccara, F., & Boesecke, C. et al. (2011). Prevalence and prognostic significance of ECG abnormalities in HIV-infected patients: results from the Strategies for Management of Antiretroviral Therapy study. Journal Of Electrocardiology, 44(6), 779-785. doi: 10.1016/j.jelectrocard.2010.10.027
Triant, V., Lee, H., Hadigan, C., & Grinspoon, S. (2007). Increased Acute Myocardial Infarction Rates and Cardiovascular Risk Factors among Patients with Human Immunodeficiency Virus Disease. The Journal Of Clinical Endocrinology & Metabolism, 92(7), 2506-2512. doi: 10.1210/jc.2006-2190
Tseng, Z., Secemsky, E., Dowdy, D., Vittinghoff, E., Moyers, B., & Wong, J. et al. (2012). Sudden Cardiac Death in Patients With Human Immunodeficiency Virus Infection. Journal Of The American College Of Cardiology, 59(21), 1891-1896. doi: 10.1016/j.jacc.2012.02.024
Dubé, M., Lipshultz, S., Fichtenbaum, C., Greenberg, R., Schecter, A., & Fisher, S. (2008). Effects of HIV Infection and Antiretroviral Therapy on the Heart and Vasculature. Circulation, 118(2), e36-40. doi: 10.1161/circulationaha.107.189625
Kent, S., Bromfield, S., Burkholder, G., Falzon, L., Oparil, S., & Overton, E. et al. (2016). Ambulatory Blood Pressure Monitoring in Individuals with HIV: A Systematic Review and Meta-Analysis. PLoS One, 11(2), e0148920. doi: 10.1371/journal.pone.0148920
Brouillette, J., Cyr, S., & Fiset, C. (2019). Mechanisms of Arrhythmia and Sudden Cardiac Death in Patients With HIV Infection. Canadian Journal Of Cardiology, 35(3), 310-319. doi: 10.1016/j.cjca.2018.12.015
Nauffal, V., C Wu, K., Ashikaga, H., Kirk, G., & Post, W. (2017). HIV and Ventricular Arrhythmia Susceptibility: Insights from Cardiac Patch Monitoring. Journal Of Clinical Case Reports, 7(11). doi: 10.4172/2165-7920.10001045
Trickey, A., May, M., Vehreschild, J., Obel, N., Gill, M., & Crane, H. et al. (2016). Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy. PLoS One, 11(8), e0160460. doi: 10.1371/journal.pone.0160460
Hsu, J., Li, Y., Marcus, G., Hsue, P., Scherzer, R., Grunfeld, C., & Shlipak, M. (2013). Atrial Fibrillation and Atrial Flutter in Human Immunodeficiency Virus-Infected Persons. Journal Of The American College Of Cardiology, 61(22), 2288-2295. doi: 10.1016/j.jacc.2013.03.022
Jensen, P., Johnson, K., Floyd, J., Heckbert, S., Carnahan, R., & Dublin, S. (2012). A systematic review of validated methods for identifying atrial fibrillation using administrative data. Pharmacoepidemiology And Drug Safety, 21, 141-147. doi: 10.1002/pds.2317
Sanders, J., Steverson, A., Pawlowski, A., Schneider, D., Achenbach, C., Lloyd-Jones, D., & Feinstein, M. (2018). Atrial arrhythmia prevalence and characteristics for human immunodeficiency virus-infected persons and matched uninfected controls. PLoS One, 13(3), e0194754. doi: 10.1371/journal.pone.0194754
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
