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Methadone and QT prolongation in HIV-infected patients

      We read with great attention the article by Gil et al
      • Gil M
      • Sala M
      • Anguera I
      • Chapinal O
      • Cervantes M
      • Guma J.R
      • Segura F
      QT prolongation and torsades des pointes in patients infected with human immunodeficiency virus and treated with metadone.
      on the QT prolongation and Torsades des pointes (TdP) in HIV-infected patients who received methadone. Although it has been reported that the daily methadone dose correlated positively with the QTc interval,
      • Krantz M.J
      • Kutinsky I.B
      • Robertson A.D
      • Mehler P.S
      Dose-related effects of methadone on QT prolongation in a series of patients with torsade de pointes.
      in HIV-infected patients, a QTc prolongation could be due to other causes that may enhance the effect of methadone on the ventricular potential duration, even at a lower dosage. A prolongation of QTc could be observed in patients with HIV-associated dilated cardiomyopathy as a consequence of myocarditis associated with fibrous degeneration of the conduction system
      • Barbaro G
      • Di Lorenzo C
      • Grisorio B
      • Barbarini G
      Gruppo Italiano per lo Studio Cardiologico dei pazienti affetti da AIDS Investigators
      Cardiac involvement in the acquired immunodeficiency syndrome a multicenter clinical-pathological study.
      or in patients with coronary artery disease as complication of higly active antiretroviral therapy-associated metabolic syndrome.
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      References

        • Gil M
        • Sala M
        • Anguera I
        • Chapinal O
        • Cervantes M
        • Guma J.R
        • Segura F
        QT prolongation and torsades des pointes in patients infected with human immunodeficiency virus and treated with metadone.
        Am J Cardiol. 2003; 92: 995-997
        • Krantz M.J
        • Kutinsky I.B
        • Robertson A.D
        • Mehler P.S
        Dose-related effects of methadone on QT prolongation in a series of patients with torsade de pointes.
        Pharmacotherapy. 2003; 23: 802-805
        • Barbaro G
        • Di Lorenzo C
        • Grisorio B
        • Barbarini G
        • Gruppo Italiano per lo Studio Cardiologico dei pazienti affetti da AIDS Investigators
        Cardiac involvement in the acquired immunodeficiency syndrome.
        AIDS Res Hum Retroviruses. 1998; 14: 1071-1077
        • Barbaro G
        Cardiovascular manifestations of HIV infection.
        Circulation. 2002; 106: 1420-1425