Exercise Dysfunction in Patients Seropositive for the Human Immunodeficiency Virus

Abstract

To confirm the presence of exercise dysfunction in patients seropositive for the human immunodeficiency virus (HIV), 32 such patients without AIDS were evaluated with cardiopulmonary exercise testing, pulmonary function testing, bronchoalveolar lavage, chest roentgenography, and gallium scanning. No evidence of pulmonary opportunistic infection was found. When compared to an otherwise similar group of HIV-seronegative controls, the patients exercised to a significantly lower workload (195 +/- 30 versus 227 +/- 31 W, p less than 0.001). The ventilatory anaerobic threshold (VAT) values were also significantly lower for the patients (49.2 +/- 13.0 versus 61.9 +/- 9.1% of maximum predicted VO2, p less than 0.001). Nine of the patients had VAT values less than the 95% confidence interval for the controls. This subgroup exercised to a significantly lower maximum VO2 (69.9 +/- 11.2 versus 95.9 +/- 17.5% of maximum predicted VO2, p less than 0.001) and workload (165 +/- 21 versus 227 +/- 31 W) when compared to the control group. These patients demonstrated a mild tachypnea throughout exercise relative to the controls and had a significant increase in the slope of the heart rate to VO2 relationship. These findings are most consistent with a limitation of oxygen delivery to exercising muscles, which may represent occult cardiac disease in this group.

Anabolic growth hormone action improves submaximal measures of physical performance in patients with HIV-associated wasting

“…VeT is reduced in conditions characterized by excessive fatigue, including heart failure (12), chronic fatigue syndrome (33), chronic pulmonary disease (45), and acromegaly (60). In this study, VeT was significantly lower than that predicted for healthy sedentary males of similar age, body mass, and stature (18), confirming previous reports of reduced VeT in HIVinfected patients compared with healthy controls (31,47,53).…”

“…Muscle wasting is associated with impaired strength and functional performance (24) and is alleged to be the underlying cause of increased fatigue among such patients. Additionally, diminished aerobic capacity in this patient population is well demonstrated by clinical exercise testing (14,31,32,36,46,47,53). Due to the strong association between HIV-associated muscle wasting and survival, as well as the concomitant diminutions of aerobic capacity and functional status, there has been considerable interest in targeted interventions.…”

Exercise training improves cardiovascular and autonomic profiles in HIV

“…Exercise is associated with improvements in immune function [44,53], and long-term survival [29] in HIV. However, the mechanistic effects of aerobic fitness on vascular and autonomic function in HIV are not known.…”

Cardiac surgery in HIV positive patients : Growing needs and concerns. Single centre experience in an Indian setting

“…Recent studies suggest the direct role of HIV as the cause of myocarditis and heart vessel pathology. This finding points out the need of improving our knowledge about the pathogenesis, diagnosis and treatment of this kind of complication 6,7 .…”

“…All were referred for cardiac procedures from an AIDS referral centre and were currently receiving antiviral therapies. Two of the patients presented with IJTCVS Cardiac surgery in HIV patients 2008; 24: [5][6][7][8][9] tuberculous pericardial effusion causing cardiac tamponade and pleural effusion, one with rheumatic mitral stenosis, one with severe aortic valve regurgitation and one with severe calcific aortic stenosis.Two patients presented with coronary artery disease, one with Anterior wall Myocardial Infarction and post infarction unstable angina with left main disease and the other with severe unstable angina with ostio-proximal near occlusion of left anterior descending artery (Table 1) Patients undergoing aortic valve replacement were placed on cardiopulmonary bypass (CPBP) with heparinisation and aorto-right atrial cannulation with two stage venous cannula. Heart was arrested with cold blood cardioplegia given antegrade and maintained with low potassium continuous, retrograde, cold blood cardioplegia.…”