Post-exercise heart rate recovery in HIV-positive individuals on highly active antiretroviral therapy. Early indicator of cardiovascular disease?
BACKGROUND
HIV infection and its treatment, specifically protease inhibitor (PI) therapy, have been associated with an increased risk for cardiovascular disease. Heart rate recovery (HRR) following peak exercise is predictive of future cardiovascular events and mortality in the general population. Nothing is known regarding HRR in individuals infected with HIV on highly active antiretroviral therapy (HAART).


METHODS
HIV-positive subjects on HAART that included a PI (HIV+PI, n=19), HIV-positive subjects on HAART that did not include a PI (HIV+noPI, n=19) and HIV-seronegative age, gender and body mass index (BMI) matched controls (Cntl, n=15) underwent a graded maximal exercise test on a cycle ergometer to volitional exhaustion. A continuous electrocardiogram was recorded and HRR was monitored every 30 s for 2 min post exercise.


RESULTS
HRR at 1.5 and 2 min was significantly delayed in HIV-positive subjects both on and not on PI-based HAART compared with controls (P<0.01).


CONCLUSIONS
HRR is impaired in HIV-positive individuals on HAART, whether or not the HAART includes a PI, compared with age, gender, BMI, and activity level matched HIV-seronegative controls. Abnormal HRR may reflect cardio-autonomic dysfunction and may be an independent risk factor for future cardiac events in HIV-positive individuals that receive HAART.
Cade
W T
WT
Division of Endocrinology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63108-2212, USA. tcade@wustl.edu
Reeds
D N
DN
Lassa-Claxton
S
S
Davila-Roman
V G
VG
Waggoner
A D
AD
Powderly
W G
WG
Yarasheski
K E
KE
D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D016022:Case-Control Studies; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D015497:HIV-1; D006331:Heart Diseases / Q000139:chemically induced* / Q000175:diagnosis; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged