Impaired autonomic cardiovascular control in people with HIV on long-term successful treatment

Objective:People with HIV have an increased cardiovascular disease risk. Persistent inflammation and mitochondrial dysfunction are considered important contributors to impaired autonomic cardiovascular control, as evidenced by decreased baroreflex sensitivity (BRS) and heart rate variability (HRV). We assessed differences in cross-correlation BRS (xBRS) and HRV between people with and without HIV and explored associations with HIV-specific characteristics.Design:We included participants with and without HIV from the AGEhIV cohort study, and general population participants from the multiethnic HEalthy LIfe in an Urban Setting (HELIUS) study, all European men aged 50-70 years.Methods:Using a noninvasive continuous blood pressure measurement, we calculated xBRS and two HRV parameters [successive differences in normal-to-normal intervals (SDNN) and the root mean square of differences between successive normal-to-normal intervals (RMSSD)]. Regression models, adjusted for traditional cardiovascular risk factors, assessed differences in xBRS and HRV between the participant groups and associated HIV-specific characteristics.Results:xBRS, SDNN, and RMSSD were significantly higher in both control groups compared to participants with HIV. Longer time since HIV diagnosis and longer prior use of dideoxynucleosides and thymidine analogues were significantly associated with lower xBRS. Nadir CD4+ cell count was positively associated with SDNN, while longer duration of thymidine analogue use was negatively associated with SDNN and prior use of dideoxynucleosides with lower RMSSD.Conclusion:Impaired autonomic cardiovascular control in men with HIV, potentially related to prior antiretroviral drug exposure and prior immunodeficiency, might contribute to HIV-associated cardiovascular disease risk.