Electrocardiographic alterations during direct-acting antiviral therapy against hepatitis C virus

Introduction and objectives

QTc interval alterations have been described in patients receiving sofosbuvir. Our objective was to evaluate the effect of anti-hepatitis C virus drugs on the human cardiac conduction system.

Methods

We included all patients with hepatitis C virus infection that started treatment with direct-acting antivirals in a tertiary hospital between May 2016 and March 2017. Three electrocardiograms were performed in them: before starting treatment; during treatment; and at least 3 weeks after finished treatment. Heart rate, PR, QRS, and QTc intervals were compared between patients with and without sofosbuvir. Patients were followed for a mean time of 41.9 weeks.

Results

A total of 101 patients were studied, 61 received treatment with sofosbuvir and 40 without sofosbuvir. No differences were found between the 2 groups regarding heart rate, and PR intervals. There was a statistically significant enlargement of QTc in patients with sofosbuvir at the fourth week of treatment (415.3 ms vs 420.8 ms) that returned to baseline values once finalized (411.1 ms; P = .029). These differences were not observed in patients without sofosbuvir.

Conclusions

We observed a statistically significant prolongation of the QTc interval at the fourth week of treatment in patients with sofosbuvir, which returned to baseline levels once the treatment was finished. Further prospective studies are needed to assess the clinical relevance of these findings.