QT prolongation in HIV-positive patients: Review article

Indian Heart J. 2019 Nov-Dec;71(6):434-439. doi: 10.1016/j.ihj.2019.11.259. Epub 2019 Dec 3.


Introduction: Antiretrovirals have immensely increased the average life expectancy of HIV-positive patients. However, the incidence of QT interval prolongation and other arrhythmias has also increased.

Methods: Pubmed and Google Scholar were searched for relevant literature published between 1990 and 2019.

Results and discussion: HIV-positive patients with high viral load, low CD4 count, chronic inflammation, and autonomic neuropathy can develop QT interval prolongation. Another factor prolonging QT interval includes exposure to the HIV transactivator protein, which inhibits hERG K (+) channels controlling IKr K (+) currents in cardiomyocytes. Protease inhibitors inhibiting the CYP3A4 enzyme can also lead to QT interval prolongation. QT interval prolongation can potentially be exacerbated by opioids, antipsychotics, antibiotics, and antifungals, the adjunct medications often used in HIV-positive patients. Hepatic insufficiency in seropositive patients on antiretrovirals may also increase the risk of QT interval prolongation.

Conclusion: Baseline and follow-up EKG in the susceptible population is suggested.

Keywords: Antiretroviral; HIV-positive; QT-interval; Sudden cardiac death; Torsades de pointes.

Publication types

  • Review

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Anti-Retroviral Agents / adverse effects
  • Antiretroviral Therapy, Highly Active / adverse effects
  • Arrhythmias, Cardiac / etiology
  • Autonomic Nervous System Diseases / complications
  • CD4 Lymphocyte Count
  • Electrocardiography*
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Protease Inhibitors / adverse effects
  • Hepatitis B, Chronic / complications
  • Hepatitis C, Chronic / complications
  • Humans
  • Inflammation
  • Methadone / adverse effects
  • Opiate Substitution Treatment / adverse effects
  • Viral Load


  • Analgesics, Opioid
  • Anti-Retroviral Agents
  • HIV Protease Inhibitors
  • Methadone