QT-Prolongation and Ventricular Tachycardia in HIV Patient with Highly Active Antiretroviral

Therapy (Possible Cause)

ABSTRACT

Background :
The growing global epidemic of HIV/AIDS has made it the fourth leading cause of the wordwide
death. HIV/AIDS represents a growing concern to healthcare workers and physians in the world with a
current estimed prevalence of close to 40 million worldwide with HIV/AIDS.1 Treatment options for
HIV infection have greatly expanded in the past few years, include the combination of regiments that
significantly prolong survival of HIV-affected individuals.2 One of the regiments, called highly active
antiretroviral therapy (HAART). This therapy has greatly increased the potential for drug interactions
and risks for serious adverse effects. HIV population may be particularly prone to develope long QT
syndrome and ventricular tachycardia.3

Case :
A 36 years old female, came with heart palpitations and shortness of breath. This is experienced by
patient since 3 days before entered the hospital. Patient had been diagnosed with HIV since 3 years ago
and consumpted of antiretroviral drugs. Patient often feels heart palpitations and the complaints are
more heavier in these 3 days. Patient consumes Lamivudine 150 mg twice a day and Efavirenz 600 mg
once a day routinely. The other physical examinations were normal . At the ECG examination was
found monomorphic Ventricular Tachycardia with rates 200x/minute. The patient was treated with
Amiodarone 150 mg injection in 10 minutes, followed by Amiodarone 900 mg IV maintenance in 24
hours (360 mg in the first 6 hours followed by 540 mg in the next 16 hours). Then the patient
performed a repeat ECG examination and the results was Sinus Rhytm and QT-Prolongation (corrected
QT interval 539 ms). Laboratory results were within normal limits. Examination of echocardiography
has not found any structural and functional heart abnormalities.

Discussion
Acquired long QT syndrome and ventricular tachycardia may have multiple etiologies, such as
Electrolyte imbalance and the using of any other drugs, which was not found in this patient. The
structure and function abnormalities of the heart may be excluded by echocardiography examination.
HAART drugs (Efavirenz and Lamivudine) were most likely to cause QT syndrome and ventricular
tachycardia in this patient. On one case control study has found that efavirenz was associated with an
increase risk of QT-prolongation in HIV-positive patients, while a case of torsades de pointes has been
reported shortly after the initiation of efavirenz. 4

Conclusion
Our case shows that HAART drugs (Efavienz and Lamivudine) may potentially caused QT
prolongation and Ventricular Tachycardia.

Keywords : QT-Prolongation, Ventricular Tachycardia,HIV, HAART

References :
1. Gopal, M., Bhaskaran A., Khalife W., Barbagelata A. (2009) Heart Disease in Patient with
HIV/AIDS-An Emerging Clinical Problem. Current Cardiology Review,2009,5,149-154
2. Naccarato M., Yoong D., Porte C., Fong I. (2014) Amiodarone and concurrent antiretroviral
therapy : a case report and review of the literature. Antiviral Therapy 2014; 19:329-339.
3. Efavirenz-Associated QT Prolongation and Torsade de Pointes Arrhytmia. 2002. Annals of
 Pharmacotherapy 2002;36:1006-8
4. Ritonavir-Boosted Atazanavir, Methadone, and Ventricular Tachycardia : 2 Case Report. 2008.
Clinical Infectious Diseases 2008;47:e36-8
5. Chinello P., Petrosillo. (2007). QT Interval Prolongation and Antiretroviral Treatment: Another
Point of Interest. Clinical Infection Disease 2007; 44,1388-1389.
6. Chinello, Lisena, Angeletti, Boumis, Papetti, Petrosilo. Role of Antiretroviral Treatment in
Prolonging QTc Interval in HIV-positive Patients. Journal of Infection. 2007; 54, 597-602.
7. Simabukuro-Vorhangen, Rybniker, Zoghi, Faetkenheur, Michels, and Erdmann. Case Report :
Acquired Long QT Syndrome and Torsade de Pointes Associated with HIV Infection. Case
Report in Medicine 2010.

Treatment options for HIV infection have greatly expanded in the past few years, include the
combination of regiments that significantly prolong survival of HIV-affected individuals.2 One of the
regiments, called highly active antiretroviral therapy (HAART). This therapy has greatly increased the
potential for drug interactions and risks for serious adverse effects.