Atrial fibrillation and human immunodeficiency virus type-1 infection: a systematic review. Implications for anticoagulant and antiarrhythmic therapy.
Daniele PastoriIvano MezzaromaPasquale PignatelliFrancesco VioliGregory Y H LipPublished in: British journal of clinical pharmacology (2019)
The prevalence and incidence of atrial fibrillation/flutter (AF/AFL) in patients with human immunodeficiency virus type-1 (HIV-1) infection have been poorly investigated. We performed a systematic review using PubMed and Cochrane Database of Systematic Reviews, and screening of references, searching for clinical studies reporting on the association between HIV-1 infection and AF/AFL. We also summarized the main interactions of antiretroviral agents with antithrombotic and antiarrhythmic drugs. We found a prevalence of AF/AFL ranging from 2.0% to 5.13% in patients with HIV-1, with an incidence rate of 3.6/1000 person-years. Low CD4+ count (<200-250 cells ml-1 ) and high viral load were predictors of AF/AFL. Regarding drugs interactions, nucleoside reverse transcriptase inhibitors, integrase inhibitor and maraviroc have the lowest interactions with oral anticoagulants. Among anticoagulants, dabigatran presents the most favourable profile. Most of antiarrhythmic drugs interact with protease inhibitors, with beta blockers and diltiazem having fewer interactions. The few studies available suggest a non-negligible prevalence of AF/AFL in patients with HIV-1 infection. Awareness of potential interactions with anticoagulation and antiarrhythmic drugs is needed to offer optimal management in this population.
Keyphrases
- atrial fibrillation
- human immunodeficiency virus
- antiretroviral therapy
- catheter ablation
- oral anticoagulants
- hiv infected
- risk factors
- hiv positive
- left atrial
- hiv aids
- hiv infected patients
- left atrial appendage
- hepatitis c virus
- direct oral anticoagulants
- systematic review
- heart failure
- percutaneous coronary intervention
- induced apoptosis
- emergency department
- risk assessment
- cell death
- endoplasmic reticulum stress
- hiv testing
- atomic force microscopy
- cell cycle arrest
- cell therapy
- venous thromboembolism
- south africa
- bone marrow
- cell proliferation
- peripheral blood