Association of electrocardiogram abnormalities in human immunodeficiency virus infected patients with special reference to QTc interval


  • Rakesh Gaharwar Department of Medicine, G R Medical College, Gwalior, M.P., India
  • Swapnil B. Molke Department of Medicine, G R Medical College, Gwalior, M.P., India
  • Ajay Pal Singh Department of Medicine, G R Medical College, Gwalior, M.P., India
  • O. P. Jatav Department of Medicine, G R Medical College, Gwalior, M.P., India



HIV, QTc prolongation, Antiretroviral therapy


Background: Cardiac manifestations of human immunodeficiency virus (HIV) and AIDS are gaining its importance as a reason for increasing morbidity and mortality. A higher prevalence of QT prolongation has been reported among HIV infected patients. However, specific data and clinical evidences are lacking in this regard from the Indian patient population. The objective of this study was to study the ECG abnormalities in HIV patients with special reference to QTc interval.  

Methods: The study was conducted at the Anti-Retroviral Therapy (ART) Centre of the Department of Medicine, G R Medical College, Gwalior, MP India between March 2012 and November 2013. A total of 130 patients who were HIV positive and either taking antiretroviral therapy or not were included in the study. The patients with history of cardiovascular disease, drugs causing prolonged QTc except antiretroviral therapy were excluded from the study. Detailed history, examination and relevant investigations were done. ECG of all the patients was done and analysed for any abnormality. CD4 count estimation was done.

Results: Out of total 130 patients, there were 88 (67.6%) males and maximum (78.4%) no of patients were in age range of 25-44 years. Socioeconomic status of the patients was low, middle and high in 64.6 %, 23.07 and 12.3 % respectively. 77.7% patients were married, 60% were engaged in heavy physical work. ECG was normal in 79 (60.7%) patients, sinus tachycardia in 30 (19 on ART and 11 pre ART patients), LBBB in 4, features of IHD and RBBB in 3 patients each. Prolonged QTc interval was exclusively found in 11 patients (8.46%) who were on ART (p<0.0001). The QTc prolongation was more in patients with lower CD4 count, 6 patients had CD 4 count between 100-150 and 2 were with CD4 count between 150-200. Almost 50% of the patients had CD 4 count <300.

Conclusions: ECG was abnormal in 39.2 % HIV positive patients and was more in patients who were on ART. The most common abnormal ECG finding was sinus tachycardia. QTc prolongation was seen in 8.46 % patients and all of them were on ART therapy.    


Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF. Cardiovascular disease in HIV infection. Am Heart J. 2006;151(6):1147-55.

Amado Costa L, Almeida AG. Cardiovascular disease associated with human immunodeficiency virus: a review. Rev Port Cardiol. 2015;34(7-8):479-91.

Chow D, Young R, Valcour N, Kronmal RA, Lum CJ, Parikh NI, et al. HIV and coronary artery calcium score: comparison of the Hawaii aging with HIV cardiovascular study and Multi-Ethnic Study of Atherosclerosis (MESA) cohorts. HIV Clin Trials. 2015;16(4):130-8.

Paula AA, Falcão MC, Pacheco AG. Metabolic syndrome in HIV-infected individuals: underlying mechanisms and epidemiological aspects. AIDS Res Ther. 2013;10(1):32.

Leidig GA Jr. Clinical, echocardiographic, and electrocardiographic resolution of HIV-related cardiomyopathy. Mil Med. 1991;156(5):260-1.

Wongcharoen W, Suaklin S, Tantisirivit N, Phrommintikul A, Chattipakorn N. QT dispersion in HIV-infected patients receiving combined antiretroviral therapy. Ann Noninvasive Electrocardiol. 2014;19(6):561-6.

Moreno T. Pérez I, Isasti G, Cabrera F, Santos J, Palacios R. Prevalence and factors associated with a prolonged QTc interval in a cohort of asymptomatic HIV-infected patients. AIDS Res Hum Retroviruses. 2013;29(9):1195-8.

Patel N, Veve M, Kwon S, McNutt LA, Fish D, Miller CD. Frequency of electrocardiogram testing among HIV-infected patients at risk for medication-induced QTc prolongation. HIV Med. 2013;14(8):463-71.

Singh M, Arora R, Jawad E. HIV protease inhibitors induced prolongation of the QT interval: electrophysiology and clinical implications. Am J Ther. 2010;17(6):e193-201.

Chatterton-Kirchmeier S, Camacho-Gonzalez AF, McCracken CE, Chakraborty R, Batisky DL. Increased prevalence of elevated blood pressures in HIV-infected children, adolescents and young adults. Pediatr Infect Dis J. 2015;34(6):610-4.

Bandarkar PN, Mohd. Shafee, Kannan K, Jogdand GS. Socio-demographic profile of HIV patients at ICTC, CAIMS, Karimnagar. Int J Biol Med Res. 2011;2(4):1023-5.

Soliman EZ, Prineas RJ, Roediger MP, Duprez DA, Boccara F, Boesecke C, et al. Prevalence and prognostic significance of ECG abnormalities in HIV-infected patients: results from the Strategies for Management of Antiretroviral Therapy (SMART) Study. J Electrocardiol. 2011;44(6):779-85.

Mahmoud U. Sani, Basil N. Okeahialam. QTc interval prolongation in patients with HIV and AIDS. J Natl Med Assoc. 2005;97(12):1657-61.

Hunt K, Hughes CA, Hills-Nieminen C. Protease inhibitor-associated QT interval prolongation. Ann Pharmacother. 2011;45(12):1544-50.

Kocheril AG, Bokhari SA, Batsford WP, Sinusas AJ. Long QTc and Torsades de pointes in human immunodeficiency virus disease. Pacing Clin Electrophysiol. 1997;20(11):2810-6.

Reinsch N, Buhr C, Krings P, Kaelsch H, Neuhaus K, Wieneke H, et al. Prevalence and risk factors of prolonged QTc interval in HIV-infected patients: results of the HIV-HEART study. HIV Clin Trials. 2009;10(4):261-8.

Sakowski C, Starc V, Smith SM, Schlegel TT. Sedentary long-duration head-down bed rest and ECG repolarization heterogeneity. Aviat Space Environ Med. 2011;82(4):416-23.

Qaqa AY, Shaaban H, DeBari VA, Phung S, Slim J, Costeas CA, et al. Viral load and CD4+ cell count as risk factors for prolonged QT interval in HIV-infected subjects: a cohort-nested case-control study in an outpatient population. Cardiology. 2010;117(2):105-11.

Castillo R, Pedalino RP, El-Sherif N, Turitto G. Efavirenz associated QT prolongation and Torsade de Pointes arrhythmia. Ann Pharmacother. 2002;36(6):1006-8.






Original Research Articles