Characterization and natural course of cardiac autonomic nervous dysfunction in HIV-infected patients.
OBJECTIVE
To examine the degree, pattern, and natural history of cardiac autonomic nervous dysfunction in patients infected with HIV.


METHODS
Cross-sectional and prospective longitudinal cohort study.


METHODS
Primary care and tertiary referral university centre.


METHODS
Thirty-five consecutive HIV-infected patients who had either not yet developed AIDS (15 pre-AIDS patients) or who were at the Centers for Disease Control and Prevention (CDC) AIDS stage (n = 20), and 29 healthy age- and sex-matched HIV-negative controls.


METHODS
Computer-aided power spectral analysis of 15 standardized parameters of heart-rate variability (HRV).


RESULTS
Pre-AIDS patients as a group did not exhibit any HRV parameters to be significantly different from healthy controls (P > 0.017), whereas AIDS patients demonstrated reduced HRV in 14 parameters (93.3%) compared with healthy subjects (p > 0.017). Median proportion of abnormal HRV parameters (< 10th percentile of controls) per individual was 9.1% in pre-AIDS patients and 61.3% in AIDS patients (P = 0.0347). Progressive CDC stages inversely correlated to 10 HRV parameters (66.7%; -0.50 < or = r < or = -0.36; P < 0.05). Follow-up testing in 10 pre-AIDS and six AIDS patients after 6-16 months (median, 12.5 months) did not reveal deterioration of HRV (P < 0.05). A dysautonomia symptom score correlated to 10 HRV parameters (66.7%; -0.14 < r < -0.55; P < 0.05).


CONCLUSIONS
Cardiac autonomic nervous dysfunction is severe in AIDS patients, although not significant in pre-AIDS patients. Cardiac autonomic nervous dysfunction proceeds with HIV disease progression, although its individual course is slow.
Becker
K
K
Department of Gastroenterology and Infectious Diseases, Heinrich Heine University Medical Centre, Dusseldorf, Germany.
Görlach
I
I
Frieling
T
T
Häussinger
D
D
D000293:Adolescent; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies