Cardiac autonomic dysfunction in AIDS is not secondary to heart failure

Heart rate variability (HRV) is a marker of cardiovascular autonomic tone, and is also known to be reduced in association with cardiac dysfunction. Abnormal autonomic function tests are common in HIV infected individuals, but the contribution of heart disease to such findings is not known. Spectral analysis of heart rate variability is a sensitive technique for measurement of cardiovascular autonomic function, which also allows differential assessment of parasympathetic and sympathetic components. The aim of this study was to characterise the nature of autonomic dysfunction in patients with AIDS and to compare our findings with those seen in HIV seronegative patients with established heart disease.

HRV was measured prospectively by spectral analysis in 10 subjects with dilated cardiomyopathy (age 45.7+/-6.9 years), 10 subjects with AIDS and no clinical evidence of heart disease (age 37.9+/-5.4 years), and 10 healthy HIV seronegative controls (age 41.7+/-13.9 years).

All components of HRV were reduced in subjects with cardiomyopathy (P<0.005), and markedly so in subjects with AIDS (P<0. 0001) compared with controls.

HIV infection may be associated with severe global autonomic dysfunction, which is not related to heart disease.