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Abstract
Effect of alternate treatment protocols on the incidence of electrocardiographic abnormalities among HIV infected adults in the SMART trial
Prineas R.1, Roediger M.2, Carr A.3, El-Sadr W.4, Esser S.5, Grandits G.6, Knysz B.7, Palfreeman A.8, SMART Study Group and INSIGHT
Objectives: The SMART trial compared strategies of continuous antiretroviral therapy (ART) (viral suppression arm; VS) and CD4-guided ART (drug conservation arm; DC). On January 11, 2006 the trial was stopped due to increased risk of progression of HIV disease, death, and cardiovascular disease (CVD), in the DC arm. We compared the effects of VS and DC on incidence of electrocardiogram (ECG) abnormalities.
Methods: 12-lead ECGs, recorded at baseline and annually, were transmitted electronically and centrally analyzed blinded to treatment. Incidence of Q wave abnormalities during mean followup of 16 months and one-year changes in measures of cardiac function were compared between study arms for participants who had a baseline and a follow-up ECG. Cox models estimated hazard ratios (HRs) (DC/VS) adjusted for demographics, clinical history, HIV-related parameters and ART status at baseline. Changes between treatment groups for heart rate and spatial QRS/T Angle (a global measure of repolarization) were compared using ANOVA and adjusted for age, race and sex.
Results: 1123 participants (41%) in the DC and 1078 (39%) in the VS arm had a baseline and at least one follow-up ECG. The DC arm had a higher incidence of Q wave abnormalities (signifying myocardial damage) compared to the VS arm: HR 1.48, 95%CI 1.06, 2.07. There was also an increase in resting heart rate, and in the QRS/T spatial angle (each of which indicates increased risk of future CVD mortality) in the DC arm.
Conclusions: Intermittent, CD4-guided ART was associated with evidence of myocardial damage, increasing repolarization abnormality, and increase in heart rate – consistent with the outcome in the main trial results of excess CVD outcomes in the DC arm.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
Abstract no.
WEPEB077
Suggested Citation
"PrineasR., et al.
Effect of alternate treatment protocols on the incidence of electrocardiographic abnormalities among HIV infected adults in the SMART trial.
Poster exhibition:
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention:
Abstract no.
WEPEB077"
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