Spanish investigators have identified a high prevalence of a potentially life-threatening disturbance in heart rhythm among HIV-positive people receiving methadone maintenance therapy. ECG examinations showed that 36% of their participants had QTc prolongation, a condition that can lead to sudden cardiac-related death.
Risk factors included liver cirrhosis caused by hepatitis C virus (HCV), not taking antiretroviral therapy and higher doses of methadone. The study is published in the online edition of Clinical Infectious Diseases. The investigators suggest that HIV-positive people taking methadone should have ECG examinations.
A majority of patients in the study were also taking other medications that might affect the QT interval but this risk factor was less significant, the study authors estimate.
Jay W. Mason of the University of Utah School of Medicine, author of an accompanying editorial, believes the study has wide clinical significance, especially as it adds to what is already known about the risks associated with methadone maintenance therapy: “Because there are safer, effective alternatives to methadone for both maintenance programs and pain relief, should methadone be withdrawn from the market?”, he asks.
Cardiovascular disease is now an importance cause of serious illness and death in people with HIV. There is a higher prevalence of prolongation of the QTc interval – an important marker of the regularity of heart rhythm – among people with HIV compared to HIV-negative individuals. Prolongation of QTc can lead to a condition called Torsades de Pointes, and to death because of serious irregularities in heartbeat.
