Association between exposure to Efavirenz and substrates of dysrhythmia in HIV‐infected young adults

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2021-10, Vol.44 (10), p.1448-1456
• Main Authors: Hosseini, Zahra, Mollazadeh, Reza, Dehghan‐Manshadi, Seyed‐Ali, Mohebi, Mehrnaz, Eslami, Masoud, Sadre‐Bafghi, Seyed‐Ali, Akbari, Ali, Ghodsi, Saeed
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Alkynes - adverse effects; Antiretroviral drugs; antiretroviral treatment; Asymptomatic; Benzoxazines - adverse effects; Cardiac arrhythmia; Cardiovascular disease; Clinical Investigations; Cyclopropanes - adverse effects; dysrhythmia; ECG Holter monitoring; Efavirenz; Electrocardiography; Family medical history; Female; Heart rate; HIV; HIV Infections - complications; HIV Infections - diagnosis; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Immune system; Male; Retrospective Studies; Standard deviation; Ventricular Premature Complexes - chemically induced; Ventricular Premature Complexes - diagnosis; Ventricular Premature Complexes - epidemiology; Young Adult
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.23705

Background Dysrhythmia and sudden cardiac arrest occur more likely in HIV patients than healthy subjects. Thus, we need to examine dysrhythmias adverse effects of medications including Efavirenz as early as possible especially in young subjects. Hypothesis Efavirenz might have contributed to increased risk of developing common types of dysrhythmia in young HIV infected patients. Methods We performed a retrospective cohort study among 62 patients on Efavirenz and 38 controls. All participants were under 40 years old without cardiovascular disease. Total significant dysrhythmia in 24‐hour ECG monitoring was the primary endpoint determined as the composite of high premature ventricular contraction (PVC) (>500 beats per 24 hours), high premature atrial contraction (PAC) (>500 bp24h), sinus pause, atrioventricular blocks, ventricular tachycardia, prolonged QTc, and low heart rate variability (HRV). Modified composite dysrhythmia consisted of low HRV (SD of normal‐to‐normal [SDNN]), high PVC and prolonged QT. Results Mean heart rate, Efavirenz regimen, male gender, and CD4 count predicted total dysrhythmia. Odds ratios were 1.108, 2.90, 4.36, and 0.96, respectively. The incidence of total dysrhythmia, high PVC, high PAC, low HRV(SDNN), and prolonged QTc were 54.8%, 41.85%, 9.71%, 45.2%, and 12.9% in patients on Efavirenz against 42.11%, 31.64%, 0%, 34.2%, and 7.91% in controls, respectively (p‐values: .031, .001,