Autonomic dysfunction in HIV patients on antiretroviral therapy: studies of heart rate variability.
BACKGROUND
The presence of autonomic dysfunction in HIV patients is largely unknown. Early studies found autonomic dysfunction in patients with AIDS. Introduction of highly active antiretroviral combination therapy (ART) has dramatically changed the course of the disease and improved prognosis and decreased morbidity. At present it is not known whether introduction of ART also has decreased autonomic dysfunction.


OBJECTIVE
To evaluate whether autonomic dysfunction is present in an ART-treated HIV population.


METHODS
HIV patients receiving ART for at least 3 years (n = 16) and an age-matched control group of healthy volunteers (n = 12) were included. All were non-smokers, non-diabetic and had never received medication for dyslipidaemia or hypertension. Following a 10 min resting period a 5 min ECG recording was performed. Heart rate variability (HRV) analysis was performed in accordance with current guidelines and data reported as median (interquartile range).


RESULTS
The resting heart rate was higher in HIV patients compared with controls [69 (62-74) versus 57 (52-60); P<0.001]. Total HRV measured as standard deviation of normal-to-normal (SONN) was lower in the HIV group compared with the controls [36 (25-55) versus 74 (57-84) ms; P<0.01] as was parasympathetic activity measured as square root of the mean squared difference of successive normal-to-normal intervals (RMSSD) [22 (9-30) versus 35 (24-62) ms; P<0.05]. Low frequency power was lower in the HIV group compared with the control group [294 (161-602) versus 946 (711-1668) ms(2); P<0.01]. High frequency power as well as systolic and diastolic blood pressure did not differ between the groups.


CONCLUSIONS
The HIV patients in ART have increased resting heart rate and decreased short-term heart rate variability indicating parasympathetic dysfunction.
Lebech
Anne-Mette
AM
Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark.
Kristoffersen
Ulrik Sloth
US
Mehlsen
Jesper
J
Wiinberg
Niels
N
Petersen
Claus Leth
CL
Hesse
Birger
B
Gerstoft
Jan
J
Kjaer
Andreas
A
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001342:Autonomic Nervous System Diseases / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D015658:HIV Infections / Q000503:physiopathology* / Q000517:prevention & control*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged
D019380:Anti-HIV Agents