Evaluation of Cardiac Autonomic Dysfunction in Human Immunodeficiency Virus Infection and its Correlation with CD4 Levels

Introduction: The occurrence of autonomic dysfunction in human immunodeficiency virus (HIV) patients impacts their health care in several ways. Extra precaution is needed during invasive surgical procedures are to be done. Whether dys-autonomia is related to severity of HIV disease is still a matter of controversy. Materials and Methods: This was a prospective, hospital-based study. 50 patients (25 HIV without AIDS and 25 HIV with AIDS) and 50 healthy age-and sex-matched controls were enrolled. Autonomic function was assessed by the following autonomic function tests. (1) Systolic blood pressure (BP) response to standing, (2) Diastolic BP response to the persistent handgrip, (3) Heart rate response to standing, (4) Heart rate response to Valsalva maneuver - Valsalva ratio, and (5) Heart rate variation to deep breathing. Grading was given for each autonomic function test. Results were classified into normal, borderline, and abnormal (scored 0.1 and 2, respectively). Results: Mean age of patients in the study group was 35.08 +/- 8.2 years and that of the control group was 35.12 +/- 8.6 years. The majority of patients were in the age group of 26-35 years. Total number of males was 42 (84%) and females 8 (16%). 30% of HIV with AIDS had autonomic dysfunction and 12% of HIV without AIDS had an abnormal autonomic function. Abnormal Valsalva response was present in 60% of HIV with AIDS and in 40% of HIV without AIDS. Abnormal diastolic BP response to sustained handgrip was present in 36% of HIV with AIDS and in 20% of HIV without AIDS. Abnormal heart rate response to deep breathing was present in 48% of HIV with AIDS and in 36% of HIV without AIDS. Conclusions: There was significant autonomic nervous system dysfunction in both HIV without AIDS and HIV with AIDS. Reduced heart rate variability was the most common manifestation of autonomic dysfunction noted in both HIV groups.