title: Autonomic nervous system dysfunction associated with HIV infection in intravenous heroin users.
abstract: OBJECTIVE
  To evaluate the presence of autonomic nervous system (ANS) involvement in HIV-positive drug users.
  
  
  METHODS
  We investigated 37 HIV-positive (and 18 HIV-negative controls) intravenous heroin users who were without symptoms and signs of autonomic or peripheral neuropathy.
  
  
  METHODS
  The patients were clinically and immunologically assessed and subjected to a battery of five cardiovascular reflex function tests.
  
  
  RESULTS
  The tests revealed ANS involvement in 22 HIV-positive subjects but only in one HIV-negative subject. Immunoglobulin (Ig) G and C1q immune complex levels were significantly higher in HIV-positive subjects with severe cardiovascular reflex function tests alteration compared to those with normal tests. In a follow-up of 17 HIV-positive subjects, nine presented deteriorated reflexes in the tests and higher IgG immune complex levels.
  
  
  CONCLUSIONS
  The results confirm that, by using sufficiently sensitive tests, signs of preclinical autonomic neuropathy can frequently be found in HIV-positive intravenous heroin users, as previously observed in homosexual patients, and suggest the existence of an HIV-related autoimmune pathogenesis. Early diagnosis of ANS involvement could be important, since the presence of autonomic dysfunction could increase the risk of cardiorespiratory arrest during invasive procedures.
authors.affiliation: Fatebenefratelli Hospital, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Villa
authors.forename: V
authors.initials: V
authors.lastname: Foresti
authors.forename: F
authors.initials: F
authors.lastname: Confalonieri
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D015483:HIV Antibodies; D015658:HIV Infections / Q000276:immunology / Q000503:physiopathology*; D003932:Heroin; D006801:Humans; D008297:Male; D008875:Middle Aged; D015819:Substance Abuse, Intravenous / Q000503:physiopathology*
chemical_list: D015483:HIV Antibodies; D003932:Heroin