Cardiac Electrical Changes during Co-administration of Artemether-lumefantrine and Atazanavir/Ritonavir in HIV-infected Nigerian Adults

Abstract

Background: Malaria and HIV infections are both major public health problems in Africa with significant morbidity and mortality. Atazanavir and artemether-lumefantrine are used in the treatment of HIV and Malaria respectively which are co-administered when there is co-infection with both diseases. Both drugs are known to independently cause cardiac electrical abnormalities. In addition, atazanavir inhibits CYP3A4 which is the enzyme that metabolizes lumefantrine with the potential for increased cardiac electrical abnormalities. We, therefore, assessed the cardiac electrical activities during the co-administration of atazanavir and artemether-lumefantrine. Method: Forty-one consecutive HIV-infected adults attending the Anti-retroviral therapy clinic in a Nigeria General hospital were enrolled on the study using the convenience sampling technique. Study participants had electrocardiographic tracings done before (day 0) and after treatment with artemether/lumefantrine (days 3 and 7). Result: There was an increase in the mean heart rate from day 1 through day 7 but the mean heart rates were within normal limits. In contrast, there was a progressive decline in the mean PR interval from day 0 through day 7 which was not statistically significant. There was also a significant increase in corrected QT interval (QTc) between day 0 and day 3 and day 0 and day 7. Though the value of the mean QTc on day 3 (414.83±34.88ms) and day 7 (411.41 ± 22.63ms) remained within the normal limit, 5% (2) of the participant had prolonged QTc. Conclusion: The results of this study suggested that there may be potential drug-drug interaction resulting from the co-administration of atazanavir based antiretroviral drug and artemether-lumefantrine especially in the prolongation of QTc interval.