title: Protease inhibitors and cardiac autonomic function in HIV-infected patients: a cross-sectional analysis from the Strategies for Management of Antiretroviral Therapy (SMART) Trial.
abstract: OBJECTIVE
  To compare cardiac autonomic function as measured by heart rate variability for HIV-infected participants taking protease inhibitors (PIs) with those taking a non-nucleoside reverse transcriptase inhibitor without a PI (NNRTI-no PI) regimen.
  
  
  METHODS
  Cross-sectional analysis.
  
  
  METHODS
  Multicentre study.
  
  
  METHODS
  2998 participants (average age 44 years, 28% females) enrolled in the Strategies for Management of Antiretroviral Therapy (SMART) trial.
  
  
  METHODS
  Heart rate and two heart rate variability measures (the SD of all filtered RR intervals over the length of the recording (SDNN) and the root mean square of successive differences in normal RR intervals (rMSSD)).
  
  
  RESULTS
  At study entry, 869 participants were taking a boosted PI (PI/r), 579 a non-boosted PI and 1550 an NNRTI-no PI. Median values (IQR) of heart rate, SDNN and rMSSD were: 68 (60-75) beats/min (bpm), 21 (13-33) ms, 22 (13-35) ms in the PI/r group, 68 (60-75) bpm, 21 (13-33) ms and 21 (14-33) ms in the non-boosted PI group and 69 (62-77) bpm, 20 (13-31) ms and 21(13-33) ms in the NNRTI-no PI group. After adjustment for baseline factors, for those given PI/r and non-boosted PI, heart rate was 2.2 and 2.8 bpm, respectively, lower than the NNRTI-no PI group (p<0.001 for both). On the other hand, compared with the NNRTI-no PI group, log SDNN and log rMSSD were significantly greater for those in the non-boosted PI (p values for baseline adjusted differences in log-transformed SDNN and rMSSD were 0.004 and 0.001) but not for those in the PI/r group at the 0.01 α-level.
  
  
  CONCLUSIONS
  Compared to an NNRTI-no PI regimen, heart rate was lower for those taking a PI/r or non-boosted PI and heart rate variability was greater, reflecting better cardiac autonomic function, for those taking a non-boosted PI regimen but not PI/r.
authors.affiliation: Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences Wake Forest School of Medicine, Division of Public Health Sciences, Winston Salem, North Carolina, USA.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.forename: Mollie P
authors.initials: MP
authors.lastname: Roediger
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Duprez
authors.forename: Hernando
authors.initials: H
authors.lastname: Knobel
authors.forename: Richard
authors.initials: R
authors.lastname: Elion
authors.forename: James D
authors.initials: JD
authors.lastname: Neaton