Серцево-судинні ураження у ВІЛ-інфікованих хворих
стають все більш домінуючими причинами захворюваності та
смертності. Зважаючи на те, що ВІЛ-інфіковані пацієнти
мають значний ризик розвитку пролонгації QT, вимірювання
цього електрокардіографічного інтервалу має велике клінічне
значення, головним чином, тому, що його подовження може
асоціюватися з підвищеним ризиком раптової серцевої смерті.HIV-infected patients are at increased risk of
cardiovascular disease. To verify the affections of the cardiovascular
system in HIV-infected patients at an early stage it is important to
find simple prognostic markers, such as the study of bioelectrical
activity of the heart. ECG is a useful tool in screening patients for
HIV as electrocardiographic changes may precede echocardiography
violation. Particular attention should be paid to the analysis of
ventricular complex, namely the length of the electrical ventricular
systole. HIV-infected patients with significant risk of QT
prolongation drug for several reasons. First, these patients are prescribed drugs (ARVs, antibiotics, antifungals, psychotropic,
antihistamines, etc.) against most infections and therefore the
prevalence of pharmacokinetic/pharmacodynamic drug interactions
is associated with prolongation of QTs is high. Secondly, some
antiretroviral drugs are directly associated with this disorder

Boyko, Ju.I.

Vozna, Kh.I.

Electronic Sumy State University Institutional Repository

МІНІСТЕРСТВО ОСВІТИ І НАУКИ УКРАЇНИ СУМСЬКИЙ ДЕРЖАВНИЙ УНІВЕРСИТЕТ  КАФЕДРА ІНФЕКЦІЙНИХ ХВОРОБ З ЕПІДЕМІОЛОГІЄЮ ГО «АСОЦІАЦІЯ ІНФЕКЦІОНІСТІВ СУМЩИНИ»          Інфекціійніі   хвороби    в  практиціі   ліікаря-іінтернііста:    сучасніі   аспекти   Infectious diseases in practice of physician-internist: modern aspects    Матеріали Всеукраїнської науково-практичної конференції, присвяченої 20-річчю кафедри інфекційних хвороб з епідеміологією  СумДУ  (Суми, 25–26 травня 2017 року)         Суми Сумський державний університет 2017Інфекційні хвороби в практиці лікаря-інтерніста: сучасні аспекти : матеріали Всеукраїнської науково-практичної конференції, м. Суми,  25–26.05.2017 р. СумДУ  66 Vozna Khrystyna I. Boyko Julia I. PROLONGATION OF THE QTc INTERVAL IN PATIENTS WITH HIV INFECTION Department of Internal Medicine and Infectious Diseases Supervisor: MD, professor V.D. Moskaliuk Higher Educational Institution "Bukovyna State Medical University", Chernovtsy, Ukraine  Возна Христина Ігорівна, Бойко Юлія Ігорівна ПРОЛОНГАЦІЯ QTc ІНТЕРВАЛУ У ПАЦІЄНТІВ З ВІЛ-ІНФЕКЦІЄЮ Кафедра внутрішньої медицини та інфекційних хвороб Науковий керівник: д-р мед. наук, професор В. Д. Москалюк ВДНЗ України «Буковинський державний медичний університет», м. Чернівці, Україна  infection@bsmu.edu.ua   Резюме. Серцево-судинні ураження у ВІЛ-інфікованих хворих стають все більш домінуючими причинами захворюваності та смертності. Зважаючи на те, що ВІЛ-інфіковані пацієнти мають значний ризик розвитку пролонгації QT, вимірювання цього електрокардіографічного інтервалу має велике клінічне значення, головним чином, тому, що його подовження може асоціюватися з підвищеним ризиком раптової серцевої смерті.  Adjective. HIV-infected patients are at increased risk of cardiovascular disease. To verify the affections of the cardiovascular system in HIV-infected patients at an early stage it is important to find simple prognostic markers, such as the study of bioelectrical activity of the heart. ECG is a useful tool in screening patients for HIV as electrocardiographic changes may precede echocardiography violation. Particular attention should be paid to the analysis of ventricular complex, namely the length of the electrical ventricular systole. HIV-infected patients with significant risk of QT prolongation drug for several reasons. First, these patients are Infectious diseases in practice of physician-internist: modern aspects : the materials of All-Ukrainian scientific and practical conference, Sumy, 25–26.05.2017. SSU  67 prescribed drugs (ARVs, antibiotics, antifungals, psychotropic, antihistamines, etc.) against most infections and therefore the prevalence of pharmacokinetic/pharmacodynamic drug interactions is associated with prolongation of QTs is high. Secondly, some antiretroviral drugs are directly associated with this disorder. The goal is to increase the effectiveness of early diagnosis of cardiovascular complications in HIV-infected patients. Subjects and methods. Under our supervision there were 136 patients with HIV infection. Among the surveyed HIV-infected patients there were 44 patients with clinical stage I, 48 with clinical stage II, 23 patients with clinical stage III and 21 with clinical stage IV. All surveyed persons with III-IV clinical stages of HIV infection were receiving first-line highly active antiretroviral therapy (HAART) schemes as recommended in Ukraine, 26 people (59.1%) were following the schemes, which are based on NNIRT, and 18 (40.9%) - on the strong IP. 32 HIV-positive people were on HAART for 3 months to 1 year, the remaining 12 patients for more than a year. Three-channel electrocardiograph SCHILLER AT-1 (Switzerland) was performed in all HIV-infected patients. The analysis was performed by conventional methods. QT interval measured from the beginning of the complex QRS (Q wave or R) by the end of wave T. Then the QT interval was corrected for heart rate using Bazetta formula: QTc = QT/√RR. QTc interval was extended for the duration of more  than 0.44 sec. Comparison group consisted of 30 healthy persons with same sex and age as of HIV-infected patients. For human rights all diagnostic and therapeutic procedures were performed with informed written consent from the patients. Results of research. Extension of electrical ventricular systole recorded among (27,2±3,8) % of HIV-infected patients in (20,5±6,1) % of patients presented with I clinical stage of HIV infection, (22,9±6,1) % of people with II clinical stage, (34,8±9,9) % and (47,6±10,9) % of HIV-positive patients with III and IV clinical stages of the disease respectively. It is important that (47,1±4,3) % of the patients take the drugs with high and moderate risk of QTc Інфекційні хвороби в практиці лікаря-інтерніста: сучасні аспекти : матеріали Всеукраїнської науково-практичної конференції, м. Суми,  25–26.05.2017 р. СумДУ  68 interval prolongation. It was found that the risk of abnormal QTc interval is higher among HIV-infected women (p<0,05), it grew up in patients with more immunodeficiency (p<0,05) and duration (over 5 years) of HIV infection (p<0,01). The increase in the electrical ventricular systole is often recorded in HIV-infected patients with right bundle branch block and in patients with ischemic changes in myocardium (p<0,05). Patients with prolongation of QTc interval when compared to the patients with normal duration of this interval had a significantly higher incidence of co-infection with hepatitis C virus (p<0,05). Our results showed that patients who are on antiretroviral therapy based on enhanced protease inhibitor have significantly more abnormalities of recorded QTc interval. But you need to keep in mind that those with HIV have significant high immunodeficiency (CD4+-lymphocytes level of <349 cells/mm3) and against a background of prolonged HIV infection they take antibacterial, antifungal drugs (associated with the risk of electrical extension ventricular systole) to treat opportunistic infections. In addition, most patients who are on HAART get it for less than a year. By the establishment of direct correlation between the HIV-infected patients on HAART for enhanced IP and frequency of extension of electrical ventricular systole (r=0,22). We can not say that taking antiretroviral drugs (particularly protease inhibitors) have a significant affect on the QTc interval prolongation. Conclusions. For reliable and timely verification of lesions of the cardiovascular system in HIV-infected patients it is needed to find a simple prognostic markers, such as the study of bioelectrical activity of the heart. In the analysis of ventricular complex special attention should be paid to the duration of the electrical ventricular systole, as QT prolongation is predictive of serious cardiac arrhythmias that can cause sudden cardiac death. 

Пролонгація QTc інтервалу у пацієнтів з ВІЛ-інфекцією

SocioEconomic Challenges Journal (Sumy State University)

МІНІСТЕРСТВО ОСВІТИ І НАУКИ УКРАЇНИ 
СУМСЬКИЙ ДЕРЖАВНИЙ УНІВЕРСИТЕТ  
КАФЕДРА ІНФЕКЦІЙНИХ ХВОРОБ З ЕПІДЕМІОЛОГІЄЮ 
ГО «АСОЦІАЦІЯ ІНФЕКЦІОНІСТІВ СУМЩИНИ» 
 
 
 
 
 
 
 
 
 
Інфекціійніі   хвороби    
в  практиціі   ліікаря-іінтернііста:    
сучасніі   аспекти  
 
Infectious diseases in practice of physician-internist: modern 
aspects  
 
 
Матеріали Всеукраїнської науково-практичної конференції, 
присвяченої 20-річчю кафедри інфекційних хвороб з епідеміологією  
СумДУ 
 (Суми, 25–26 травня 2017 року) 
 
 
 
 
 
 
 
 
Суми 
Сумський державний університет 
2017
Інфекційні хвороби в практиці лікаря-інтерніста: сучасні аспекти : матеріали Всеукраїнської 
науково-практичної конференції, м. Суми,  25–26.05.2017 р. СумДУ 
 
66 
Vozna Khrystyna I. Boyko Julia I. 
PROLONGATION OF THE QTc INTERVAL IN PATIENTS 
WITH HIV INFECTION 
Department of Internal Medicine and Infectious Diseases 
Supervisor: MD, professor V.D. Moskaliuk 
Higher Educational Institution "Bukovyna State Medical 
University", Chernovtsy, Ukraine 
 
Возна Христина Ігорівна, Бойко Юлія Ігорівна 
ПРОЛОНГАЦІЯ QTc ІНТЕРВАЛУ У ПАЦІЄНТІВ З ВІЛ-
ІНФЕКЦІЄЮ 
Кафедра внутрішньої медицини та інфекційних хвороб 
Науковий керівник: д-р мед. наук, професор В. Д. Москалюк 
ВДНЗ України «Буковинський державний медичний 
університет», м. Чернівці, Україна  
infection@bsmu.edu.ua  
 
Резюме. Серцево-судинні ураження у ВІЛ-інфікованих хворих 
стають все більш домінуючими причинами захворюваності та 
смертності. Зважаючи на те, що ВІЛ-інфіковані пацієнти 
мають значний ризик розвитку пролонгації QT, вимірювання 
цього електрокардіографічного інтервалу має велике клінічне 
значення, головним чином, тому, що його подовження може 
асоціюватися з підвищеним ризиком раптової серцевої смерті. 
 
Adjective. HIV-infected patients are at increased risk of 
cardiovascular disease. To verify the affections of the cardiovascular 
system in HIV-infected patients at an early stage it is important to 
find simple prognostic markers, such as the study of bioelectrical 
activity of the heart. ECG is a useful tool in screening patients for 
HIV as electrocardiographic changes may precede echocardiography 
violation. Particular attention should be paid to the analysis of 
ventricular complex, namely the length of the electrical ventricular 
systole. HIV-infected patients with significant risk of QT 
prolongation drug for several reasons. First, these patients are 
Infectious diseases in practice of physician-internist: modern aspects : the materials of All-Ukrainian 
scientific and practical conference, Sumy, 25–26.05.2017. SSU 
 
67 
prescribed drugs (ARVs, antibiotics, antifungals, psychotropic, 
antihistamines, etc.) against most infections and therefore the 
prevalence of pharmacokinetic/pharmacodynamic drug interactions 
is associated with prolongation of QTs is high. Secondly, some 
antiretroviral drugs are directly associated with this disorder. 
The goal is to increase the effectiveness of early diagnosis of 
cardiovascular complications in HIV-infected patients. 
Subjects and methods. Under our supervision there were 136 
patients with HIV infection. Among the surveyed HIV-infected 
patients there were 44 patients with clinical stage I, 48 with clinical 
stage II, 23 patients with clinical stage III and 21 with clinical stage 
IV. All surveyed persons with III-IV clinical stages of HIV infection 
were receiving first-line highly active antiretroviral therapy 
(HAART) schemes as recommended in Ukraine, 26 people (59.1%) 
were following the schemes, which are based on NNIRT, and 18 
(40.9%) - on the strong IP. 32 HIV-positive people were on HAART 
for 3 months to 1 year, the remaining 12 patients for more than a 
year. Three-channel electrocardiograph SCHILLER AT-1 
(Switzerland) was performed in all HIV-infected patients. The 
analysis was performed by conventional methods. QT interval 
measured from the beginning of the complex QRS (Q wave or R) by 
the end of wave T. Then the QT interval was corrected for heart rate 
using Bazetta formula: QTc = QT/√RR. QTc interval was extended 
for the duration of more  
than 0.44 sec. Comparison group consisted of 30 healthy persons 
with same sex and age as of HIV-infected patients. For human rights 
all diagnostic and therapeutic procedures were performed with 
informed written consent from the patients. 
Results of research. Extension of electrical ventricular systole 
recorded among (27,2±3,8) % of HIV-infected patients in (20,5±6,1) 
% of patients presented with I clinical stage of HIV infection, 
(22,9±6,1) % of people with II clinical stage, (34,8±9,9) % and 
(47,6±10,9) % of HIV-positive patients with III and IV clinical 
stages of the disease respectively. It is important that (47,1±4,3) % of 
the patients take the drugs with high and moderate risk of QTc 
Інфекційні хвороби в практиці лікаря-інтерніста: сучасні аспекти : матеріали Всеукраїнської 
науково-практичної конференції, м. Суми,  25–26.05.2017 р. СумДУ 
 
68 
interval prolongation. It was found that the risk of abnormal QTc 
interval is higher among HIV-infected women (p<0,05), it grew up in 
patients with more immunodeficiency (p<0,05) and duration (over 5 
years) of HIV infection (p<0,01). The increase in the electrical 
ventricular systole is often recorded in HIV-infected patients with 
right bundle branch block and in patients with ischemic changes in 
myocardium (p<0,05). Patients with prolongation of QTc interval 
when compared to the patients with normal duration of this interval 
had a significantly higher incidence of co-infection with hepatitis C 
virus (p<0,05). 
Our results showed that patients who are on antiretroviral therapy 
based on enhanced protease inhibitor have significantly more 
abnormalities of recorded QTc interval. But you need to keep in 
mind that those with HIV have significant high immunodeficiency 
(CD4
+
-lymphocytes level of <349 cells/mm
3
) and against a 
background of prolonged HIV infection they take antibacterial, 
antifungal drugs (associated with the risk of electrical extension 
ventricular systole) to treat opportunistic infections. In addition, most 
patients who are on HAART get it for less than a year. By the 
establishment of direct correlation between the HIV-infected patients 
on HAART for enhanced IP and frequency of extension of electrical 
ventricular systole (r=0,22). We can not say that taking antiretroviral 
drugs (particularly protease inhibitors) have a significant affect on 
the QTc interval prolongation. 
Conclusions. For reliable and timely verification of lesions of the 
cardiovascular system in HIV-infected patients it is needed to find a 
simple prognostic markers, such as the study of bioelectrical activity 
of the heart. In the analysis of ventricular complex special attention 
should be paid to the duration of the electrical ventricular systole, as 
QT prolongation is predictive of serious cardiac arrhythmias that can 
cause sudden cardiac death. 


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Пролонгація QTc інтервалу у пацієнтів з ВІЛ-інфекцією

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SocioEconomic Challenges Journal (Sumy State University)