We present a case of a 41-year-old man complaining of chest pain, which he directly attributed to his antiretrovirals, specifically atazanavir and ritonavir. The chest pain resolved on stopping the treatment, and recurred when atazanavir was restarted, again resolving on discontinuation. Cardiovascular risk factors are an important consideration with any antiretroviral therapy but particularly with protease inhibitors. The association between atazanavir and cardiac arrhythmias has been reported elsewhere including the British National Formulary, and it may be good practice to perform electrocardiogram assessments in patients commencing and using atazanavir-based regimens.
BustiAJTsikourisJPPeetersMJ. A prospective evaluation of the effect of atazanavir on the QTc interval and QTc dispersion in HIV-positive patients. HIV Med2006; 7: 317–322.
7.
ChengSKeyesWJLarsonMG. Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block. JAMA2009; 301: 2571–2577.
8.
WilkeTGrothAMuellerS. Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace2013; 15: 486–493.
