Changes in QT interval in HIV patients treated with bedaquiline

Introduction. A modern problem of phthisiology is the treatment of patients with a combination of drug-resistant tuberculosis and HIV infection. One of the most effective modern drugs in the treatment of MDR tuberculosis is bedaquiline. However, this drug has a number of adverse effects, among which the dominant one is the cardiotoxic effect, manifested in the form of prolongation of the QT interval. The risk of cardiac adverse events is increased in patients receiving other drugs with a cardiotoxic effect in combination therapy. These include fluoroquinolones and protease inhibitors used to treat HIV infection.

Aim. To analyze the dynamics of the QT interval in patients with a combination of tuberculosis and HIV infection who received complex anti-tuberculosis and antiretroviral therapy and determination of the risks of developing cardiac complications.

Materials and methods. The analysis of the dynamics of the QTc interval values was performed in 91 patients with a combination of drug-resistant tuberculosis and HIV infection who received bedaquiline in the tuberculosis chemotherapy regimen. The inclusion criteria for the study were the presence of HIV infection, newly diagnosed tuberculosis verified by a bacteriological method with the presence of multiple or extensive drug resistance of MBT, the use of bedaquiline in the tuberculosis treatment regimen, the use of antiretroviral therapy during anti-tuberculosis chemotherapy.

Results. During the complex therapy, which included bedaquiline and other potentially cardiotoxic drugs (fluoroquinolones, protease inhibitors), in no case was there a clinically significant event or change in the QTc interval that required treatment interruption. Factor analysis revealed a potentially significant effect on the change in the QTc interval of levofloxacin and moxifloxacin in tuberculosis chemotherapy regimens.

Conclusion. Bedaquiline is a safe anti-tuberculosis drug in terms of cardiotoxic reactions in the complex therapy of tuberculosis in patients with HIV infection and is well tolerated without the development of clinically significant cardiotoxic reactions.

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