Abstract
Background
Human immunodeficiency virus (HIV) infection is associated with autonomic neuropathy. The resultant autonomic dysfunction impairs quality of life and can have fatal consequences. Our aim was to clearly define the symptoms of autonomic dysfunction in African HIV-positive patients and determine whether these symptoms were related with (a) autonomic reflex responses (b) the degree of immunosupression.
Methods
Thirty-one HIV-positive treatment-naïve African patients (mean CD4 cell count 269.5 ± 253.4/mm3) and 12 healthy controls completed a detailed questionnaire (Autonomic System Profile, Mayo Clinic, Rochester, MN) relating to specific symptoms of autonomic dysfunction. After completion of the questionnaire, subjects underwent a standard battery of autonomic reflex tests.
Results
The autonomic symptom score was higher in the male HIV-positive patients (26.7 ± 14.7 points) and female patients with CD4 <200/mm3 (24.7 ± 18.0) than sex-matched controls (male controls, 9.9 ± 6.8, P < 0.05; female controls, 8.8 ± 10.1; P < 0.05). Six patients had scores indicative of severe autonomic dysfunction (>43.8 points). The most common autonomic symptoms were: orthostatic intolerance, secretomotor and gastrointestinal dysfunction. There was no relationship between CD4 cell counts and autonomic symptom scores. The blood pressure response to sustained handgrip was blunted, but all other cardiovascular reflex tests were within the normal range or borderline.
Conclusion
African HIV-positive patients report symptoms of autonomic dysfunction, despite normal or borderline autonomic reflex responses.
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References
Barbaro G (2003) Highly active antiretroviral therapy and the cardiovascular system: the heart of the matter. Pharmacology 69:177–179.
Becker K, Görlach I, Frieling T et al (1997) Characterization and natural course of cardiac autonomic nervous dysfunction in HIV-infected patients. AIDS 11:751–757.
Brownley KA, Hurwitz BE (2003) Assessment of autonomic and cardiovascular function in HIV disease. In: Barbaro G (ed) HIV infection and the cardiovascular system. Adv Cardiol 40:105–139.
Correia D, Pertilli Rodrigues De Resende LA, Molina RJ et al (2006) Power spectral analysis of heart rate variability in HIV-infected and AIDS patients. PACE 29:53–58.
Craddock C, Pasvol G, Bull R et al (1987) Cardiorespiratory arrest and autonomic neuropathy in AIDS. Lancet 2(8549):16–18.
Ewing DJ, Clarke BF (1986) Autonomic neuropathy: its diagnosis and prognosis. Clin Endocrinol Metab 15:855–888.
Freeman R (2005) Autonomic peripheral neuropathy. Lancet 365:1259–1270.
Glück T, Degenhardt E, Schölmerich J et al (2000) Autonomic neuropathy in patients with HIV: course, impact of disease stage, and medication. Clin Auton Res 10:17–22.
Justice AC, Rabeneck L, Hays RD, et al. for the Outcomes Committee of the AIDS Clinical Trials Group (1999) Sensitivity, specificity, reliability, and clinical validity of provider-reported symptoms: a comparison with self-reported symptoms. JAIDS 21:126–133.
Lohmöller G, Matuschke A, Goebel F-D (1989) Falsch-positiver test einer autonomen neuropathie bei HIV-infektion und AIDS? Fallkontrollstudie der herzfrequenzvariabilität bei 62 HIV-positiven patienten. Med Klin 84:242–245.
Low PA, Benrus-Larson LM, Sletten DM et al (2004) Autonomic symptoms and diabetic neuropathy. A population based study. Diabetes Care 27:2942–2947.
Meyer EC, De Sommers K, Schoeman HS et al (1990) The effect of autonomic blockers on heart rate: a comparison between two ethnic groups. Br J Clin Pharmacol 29:254–256.
Miller RF, Semple SJ (1987) Autonomic neuropathy in AIDS. Lancet 2(8554):343–344.
Mittal CM, Wig N, Mishra S et al (2004) Heart rate variability in human immunodeficiency virus-positive individuals. Int J Cardiol 94:1–6.
Neild PJ, Amadi A, Ponikowski P et al (2000) Cardiac autonomic dysfunction in AIDS is not secondary to heart failure. Int J Cardiol 74:133–137.
Nzuobontane D, Ngu BK, Christopher K (2002) Cardiovascular autonomic dysfunction in Africans infected with human immunodeficiency virus. J R Soc Med 95:445–447.
Plein D, Van Camp G, Cosyns B et al (1999) Cardiac and autonomic evaluation in a pediatric population with human immunodeficiency virus. Clin Cardiol 22:33–36.
Prendergast BD (2003) HIV and cardiovascular medicine. Heart 89:793–800.
Rennie KL, Hemingway H, Kumari M et al (2003) Effects of moderate and vigorous physical activity on heart rate variability in a british study of civil servants. Am J Epidemiol 158:135–143.
Rogstad KE, Shah R, Tesfaladet G et al (1999) Cardiovascular autonomic neuropathy in HIV infected patients. Sex Transm Infect 75:264–267.
Rüttiman S, Hilti P, Spinas GA et al (1991) High frequency of human immunodeficiency virus-associated autonomic neuropathy and more severe involvement in advanced stages of human immunodeficiency virus disease. Arch Intern Med 151:2441–2443.
Ryan JM, Howes LG (2002) Relations between alcohol consumption, heart rate, and heart rate variability in men. Heart 88:641–642.
Sakhuja A, Goyal A, Jaryal AK et al (2007) Heart rate variability and autonomic function tests in HIV positive individuals in India. Clin Auton Res 17:193–196.
Scott G, Piaggesi A, Ewing DJ (1990) Sequential autonomic function tests in HIV infection. AIDS 4:1279–1282.
Shahmanesh M, Bradbeer CS, Edwards A et al (1991) Autonomic dysfunction in patients with human immunodeficiency virus infection. Int J STD AIDS 2(6):419–423.
Sherwood A, May CW, Siegel WC et al (1995) Ethnic differences in hemodynamic responses to stress in hypertensive men and women. Am J Hypertens 8:552–557.
Suarez GA, Opfer-Gehrking TL, Offord KP et al (1999) The autonomic symptom profile: a new instrument to assess autonomic symptoms. Neurology 52:523–528.
Tsuji H, Venditti FJ, Manders ES et al (1996) Determinants of heart rate variability. J Am Coll Cardiol 28:1539–1546.
UNAIDS/WHO Global Online Database: http://www.who.int/globalatlas/includeFiles/generalIncludeFiles/listInstances.asp?boID=419&Periodicity=y&cb_adminLevel=0&boCat=&PF=2005&PT=2008, (accessed on 7th November 2007).
Villa A, Foresti V, Confalonieri F (1992) Autonomic nervous system dysfunction associated with HIV infection in intravenous heroin users. AIDS 6:85–89.
Welby SB, Rogerson SJ, Beeching NJ (1991) Autonomic neuropathy is common in human immunodeficiency virus infection. J Infect 23:123–128.
Wulff EA, Wang AK, Simpson DM (2000) HIV-associated peripheral neuropathy. Epidemiology, pathophysiology and treatment. Drugs 59:1251–1260.
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Compostella, C., Compostella, L. & D’Elia, R. The symptoms of autonomic dysfunction in HIV-positive Africans. Clin Auton Res 18, 6–12 (2008). https://doi.org/10.1007/s10286-007-0451-y
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DOI: https://doi.org/10.1007/s10286-007-0451-y