Cardiovascular autonomic neuropathy in HIV-positive African patients.
OBJECTIVE
HIV infection causes cardiac autonomic neuropathy (CAN); little is known about the relevance of CAN in sub-Sahara African patients, in spite of the highest prevalence of AIDS in that population. The authors assessed prevalence rates of CAN in HIV-positive treatment-naïve African patients and investigated the correlation between degree of immunodeficiency and CAN.


METHODS
Thirty HIV-positive patients and 11 HIV-negative controls underwent a battery of cardiovascular autonomic function tests; the Ewing-Clarke score was calculated along with the stage of severity of CAN. The patients' immunological status was evaluated by CD4 T-lymphocytes counts.


RESULTS
During paced respiration of normal depth, the patients showed shorter baseline RR intervals (739.2+/-136.0 vs 846.2+/-88.7 ms; P<0.05), with an inverse correlation with CD4 counts, and lower heart rate variability (85.3+/-73.0 vs 123.0+/-46.2 ms; P<0.02). Although patients with lower CD4 counts tended to present blunted response to hand-grip and cold-face tests, no linear correlation was found between results of cardiovascular reflex tests and CD4 counts. Eight patients (27%) obtained borderline Ewing-Clarke scores; 9 patients resulted affected by early (6 pts, 20%) or intermediate (3 pts, 10%) stage of CAN.


CONCLUSIONS
Signs of HIV-related CAN are present in 30% of the African HIV+ patients observed, with no direct correlation to their immunological status. Based on the relevance of the problem and the presence of signs of CAN even in newly diagnosed and treatment-naïve patients, the authors suggest that all HIV-patients should be screened for the presence of the complication, in view of the possible serious events associated with it.
Compostella
C
C
Institute of Infectious Diseases, University of Padua, Padua, Italy.
Compostella
L
L
D'Elia
R
R
D000293:Adolescent; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult