Cardiovascular autonomic neuropathy in HIV infected patients

Abstract

Objective: To evaluate the presence and extent of autonomic dysfunction in HIV infected individuals of one ethnic group. Design: 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 staV 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 diVerences 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 diVerence 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 ×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. (Sex Transm Inf 1999;75:264-267)

Growth Hormone Treatment Improves Peripheral Muscle Oxygen Extraction-Utilization during Exercise in Patients with Human Immunodeficiency Virus-Associated Wasting: A Randomized Controlled Trial

“…Impairment in the redistribution of central circulation to active tissue resulting from autonomic dysfunction is another potential mechanism for the reduced muscle oxygen extraction-utilization observed in this patient population. Autonomic dysfunction has been reported in HIV-infected patients (51)(52)(53)(54); however, it could not be specifically elucidated using the approaches adopted in our current study.…”

Exercise training improves cardiovascular and autonomic profiles in HIV

“…A diminished autonomic profile is evident in HIVpositive individuals [12,23,24,47,48,57]. Although the relevant pathophysiologic mechanisms in HIVpositive patients are not fully elucidated, hyperchronic levels of sympathetic activity is often evident.…”

Sexual Dysfunctions

“…It has been reported ejaculatory dysfunction associated by use of didanosine (Hijazi et al 2002). The neuropathy is a possible complication by use of some antiretrovirals and may be a sexual dysfunction factor for some patients (Rogstad et al 1999). However, HIV infected individuals use a lot of other medications that are associated with decrease on sexual response.…”