Key result
First-line antiretroviral therapy was independently associated with a prolonged corrected QT interval (+11.8 ms) compared to HIV-negative controls, though major anatomical cardiac abnormalities did not differ.
Why the study?
Studies from high-income countries report impaired cardiac function in HIV-positive people, but it was unclear if these findings translate directly to the Sub-Saharan Africa context.
Does HIV infection and antiretroviral therapy use increase electrocardiographic and echocardiographic abnormalities in an urban African population?
Cross-Sectional (n=547)
No
Does HIV infection and antiretroviral therapy use increase electrocardiographic and echocardiographic abnormalities in an urban African population?
Mean Difference: 11.8 (95% CI 4.3–19.2)
Absolute Event Rate: 416% vs 402%
p-value: p=<0.01
In an urban African population, HIV infection and ART use were not associated with major structural or functional cardiac abnormalities, though ART use was linked to a prolonged QTc interval.
ART-associated QTc prolongation may warrant ECG vigilance in HIV; leaves open arrhythmia risk in urban African cohorts.
BACKGROUND: Studies from high income countries report that HIV-positive people have an impaired systolic and diastolic cardiac function compared to HIV-negative people. It is unclear if results can be translated directly to the Sub-Saharan Africa context. This study assesses electro- and echocardiographic characteristics in an urban African population, comparing HIV-positive people (treated and not yet treated) with HIV-negative controls. METHODS: We conducted a cross-sectional study in Johannesburg, South Africa. We enrolled HIV-positive participants from three randomized controlled trials that had recruited participants from routine HIV testing programs. HIV-negative controls were recruited from the community. Data were collected on demographics, cardiovascular risk factors, medical history and electrocardiographic and echocardiographic characteristics. RESULTS: In total, 394 HIV-positive participants and 153 controls were enrolled. The mean age of HIV-positive participants was 40±9 years (controls: 35±10 years), and 34% were male (controls: 50%). Of HIV-positive participants 36% were overweight or obese (controls: 44%), 23% had hypertension (controls: 28%) and 12% were current smoker (controls: 37%). Median time since HIV diagnosis was 6.0 years (IQR 2.3-10.0) and median treatment duration was 4.0 years (IQR 0.0-8.0), 50% had undetectable viral load. The frequency of anatomical cardiac abnormalities was low and did not differ between people with and without HIV. We observed no relation between HIV or anti-retroviral therapy (ART) and systolic or diastolic heart function. There was an association between ART use and corrected QT interval: +11.8 ms compared to HIV-negative controls (p<0.01) and +18.9 ms compared to ART-naïve participants (p = 0.01). We also observed a higher left ventricular mass index in participants on ART (+7.8 g/m2, p<0.01), but this association disappeared after adjusting for CD4 cell count, viral load and HIV-duration. CONCLUSION: The low number of major cardiac abnormalities in this relatively young, well managed urban African HIV-positive population is reassuring. The increase in corrected QT interval and left ventricular mass may contribute to higher cardiac mortality and morbidity in people living with HIV in the long term.
No takes yet. Share an insight, caveat, or question.
Roozen et al. (2021) conducted a cross-sectional in HIV infection (n=547). Antiretroviral therapy (ART) vs. HIV-negative controls was evaluated on Corrected QT interval (QTc) (MD 11.8 ms, 95% CI 4.3-19.2, p=<0.01). First-line antiretroviral therapy was independently associated with a prolonged corrected QT interval (+11.8 ms) compared to HIV-negative controls, though major anatomical cardiac abnormalities did not differ.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: