Electrophysiological Adverse Effects of Direct-Acting Antivirals in Patients With Chronic Hepatitis C.

Dear Editor, We read with great interest the article by DuranteMangoni et al.1 Sofosbuvir (SOF) has recently been correlated with bradyarrhythmias, especially if coadministered with amiodarone. In this study, DuranteMangoni et al assessed several electrocardiographic (ECG) parameters in 26 subjects who were consecutively treated with various SOF-based regimens. They did not observe significant changes in ECG parameters except a transient increase of QTc duration during the first week that returned to baseline values afterward. In contrast to what was reported by Renet et al2 and Fontaine et al,3 the authors concluded that SOF-based regimens could be considered safe. HIV/HCV coinfected patients are often treated with methadone and antiretrovirals, such as atazanavir and rilpivirine, which have an effect on QTc duration. Thus, we performed a similar evaluation of ECG parameters in 58 coinfected individuals treated with different SOFbased regimens from January 2015 to July 2016. ECG parameters were prospectively collected at baseline, after 1 and 4 weeks, and at the end of therapy. Compared to the study by Durante-Mangoni and colleagues, our population is larger and has several differences, especially in terms of liver fibrosis severity (Table 1). In the overall analysis, QTc duration did not change significantly over treatment (P= .31). Patients receiving atazanavir or rilpivirine had stable QTc intervals during treatment. No difference was noted for any directacting antiviral combination. At baseline, F3 (defined by a stiffness between 10 and 14 kPa) and cirrhotic subjects had comparable QTc values (408 milliseconds vs 422 milliseconds for F4 [defined by a stiffness >14 kPa] overall, 421 milliseconds for Child-Pugh-Turcotte class [CPT] A and 425 for CPT B/C), but such difference was not significant (P = .16). At week 4, F3 individuals maintained the same QTc value (407 milliseconds), but F4 patients had a slight increase to 424 milliseconds (P = 0.01). If we consider F3, CPT A (423 milliseconds), and CPT B/C Table 1. Baseline Features of Study Population