Cardiovascular autonomic neuropathy in HIV infected patients.
OBJECTIVE
To evaluate the presence and extent of autonomic dysfunction in HIV infected individuals of one ethnic group.


METHODS
Prospective, age-sex matched study.


METHODS
25 patients (seven asymptomatic (HIV), eight AIDS related complex (ARC), 10 AIDS) and 25 controls were recruited from patients and staff at the Aga Khan Hospital, Nairobi. Autonomic function was assessed by measurement of pulse rate variability on standing, rest, deep breathing, Valsalva manoeuvre, isometric exercise, cold face test, and mental stress. Blood pressure was measured during standing, supine resting, and on Valsalva manoeuvre. CD4 count was correlated with number of abnormal test results.


RESULTS
21 patients had at least one abnormal test of autonomic function compared with one control (p < 0.0001). There were significant differences between AIDS patients and controls for supine heart rate (p < 0.001), Valsalva ratio (p = 0.05), and cold face test (p = 0.05), and almost significant results for mental stress (p = 0.051). Evidence of autonomic hypersensitivity was found in response to exercise and/or mental stress in some patients with HIV or ARC. No difference was found in blood pressure measurements. Abnormalities in autonomic function occurred at all CD4 counts and all patients with four abnormal tests of heart rate variation had a CD4 count less than 300 x 10(6)/l.


CONCLUSIONS
There is evidence of substantial autonomic dysfunction in AIDS patients compared with controls and mild abnormalities in the majority of HIV infected patients studied irrespective of CD4 count. Autonomic hypersensitivity may precede loss of function in some cases.
Rogstad
K E
KE
Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield.
Shah
R
R
Tesfaladet
G
G
Abdullah
M
M
Ahmed-Jushuf
I
I
D000386:AIDS-Related Complex / Q000276:immunology / Q000503:physiopathology; D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology / Q000503:physiopathology; D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000276:immunology / Q000821:virology*; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies