Objectives:

Spectral analysis of heart rate variability (HRV) is a sensitive technique for measurement of cardiovascular neurovegetative function, which also allows differential assessment of parasympathetic and sympathetic components. Moreover, spontaneous baroreflex sensitivity (BRS) is a simple and non-invasive method for the study of the baroreflex function. The objective of this study was to evaluate the presence, nature and degree of cardiovascular neurovegetative dysfunction in HIV-infected patients compared with HIV-negative controls, and to correlate the dysfunction with stage of HIV infection and antiretroviral treatment.

Methods:

A total of 57 HIV-infected patients (29 men), aged 34–58 (median 38) years, were enrolled in the study. Twenty-two patients were at stage A, 22 patients at stage B and 13 patients at stage C, according to the CDC classification system. Forty-seven patients were receiving highly active antiretroviral therapy (HAART), and half of them were on treatment with protease inhibitors. Cardiovascular neurovegetative function was assessed by spectral analysis of HRV and by BRS method. Blood pressure and consecutive R–R intervals were recorded continuously for 20 min on supine resting, and for 20 min during a passive tilt-test. Data obtained from each CDC stage group were compared with those obtained from 14 HIV-negative controls recruited from patients and medical staff at the hospital.

Results:

HRV parameters were not statistically different among patients at CDC stages A and B in comparison with controls; when compared with controls, patients at stage C had: (i) a reduced BRS in baseline condition (8.5 ± 1.7 ms/mmHg vs. 21.8 ± 4.1 ms/mmHg; P < 0.015); (ii) a reduced increase of systolic arterial pressure during tilt-test (8.2 ± 2.0 mmHg vs. 17.0 ± 3.2 mmHg; P < 0.03); (iii) a significant difference in the low frequency (LF)/high frequency (HF) ratio (3.9 ± 1.3 vs. 13.0 ± 5.4; P < 0.019) during tilt-test, related to a different LF component (44.8 ± 6.3 vs. 75.6 ± 4.7 normalised units; P < 0.001). No differences were observed between HIV-infected patients with respect to HAART regimen.

Conclusions:

Cardiovascular dysfunction is common in association with HIV infection and occurs more frequently and with greater severity in patients with AIDS. However, it may be present in the early stages of HIV infection and progress during the illness.

Acknowledgements:

This work was funded by Ricerca Corrente IRCCS.