An abnormal electrocardiogram (ECG) is associated with increased risk of arrhythmias and sudden cardiac death (SCD). We aimed to investigate the prevalence and associated risk factors of major ECG abnormalities, prolonged QTc and prior myocardial infarction (MI), in persons living with HIV (PLWH) and uninfected controls.
PLWH aged ≥40 were recruited from the Copenhagen comorbidity in HIV infection (COCOMO) study and matched on sex and 5-year age strata to uninfected controls from the Copenhagen General Population Study. Blood pressure, lipids, glucose and hsCRP were measured. Questionnaires were used to obtain data on smoking history and medication. ECGs were recorded on the same CardioSoft electrocardiograph and categorized according to The Minnesota Code Manual of ECG Findings definition of major abnormalities. A QT interval corrected for heart rate (QTc) >440 ms in males and >460 ms in females was considered prolonged. Prior MI was defined as major Q-wave abnormalities. We calculated binomial proportion confidence intervals (95% CI) and assessed factors associated with ECG abnormalities using a logistic regression model adjusted for age, sex, smoking, dyslipidemia, diabetes, hsCRP and hypertension.
An ECG was available for 740 PLWH and 2,955 controls. PLWH were younger (median 52 vs 54), fewer had hypertension (48 % vs 63%), but more were current smokers (26% vs 12%) compared to controls. Prolonged QTc was more prevalent among PLWH (11% [9-13]) than among controls (8% [7-9]), p=.005. Prior MI was also more common in PLWH (6% [5-8]) than in controls (4% [4-5]), p=.04, but there was no difference in prevalence of major ECG abnormalities between PLWH and controls (12% [10-14]) and 12% [11-14], respectively), p=.992 (Table). In adjusted analyses, HIV was independently associated with prolonged QTc (adjusted odds ratio:1.6 [95%CI:1.2-2.1]) but not with other ECG abnormalities. Among PLWH, use of protease inhibitors, previous AIDS, CD4 count, intravenous drug use or methadone treatment were not independently associated with prolonged QTc or major abnormalities.
Prevalence of prolonged QTc was higher among PLWH compared to uninfected controls, and HIV remained associated after adjustment for cardiovascular risk factors. Although evidence indicated more ischaemic changes in PLWH, the risk seemed to be associated mainly with an adverse risk profile. These data suggest that continued awareness of QTc may be important in lowering the excess risk of SCD among PLWH.