Compostella C; Compostella L; D'Elia R
Institute of Infectious Diseases, University of Padua, Padua, Italy.
AIM: HIV infection causes cardiac
autonomic neuropathy (CAN); little is known about the relevance of CAN in
sub-Sahara African patients, in spite of the highest prevalence of AIDS in that
population. The authors assessed prevalence rates of CAN in HIV-positive
treatment-naïve African patients and investigated the correlation between
degree of immunodeficiency and CAN. METHODS: Thirty HIV-positive patients and
11 HIV-negative controls underwent a battery of cardiovascular autonomic
function tests; the Ewing-Clarke score was calculated along with the stage of
severity of CAN. The patients' immunological status was evaluated by CD4
T-lymphocytes counts. RESULTS: During paced respiration of normal depth, the
patients showed shorter baseline RR intervals (739.2+/-136.0 vs 846.2+/-88.7 ms; P<0.05),
with an inverse correlation with CD4 counts, and lower heart rate variability
(85.3+/-73.0 vs 123.0+/-46.2 ms;
P<0.02). Although patients with lower CD4 counts tended to present blunted
response to hand-grip and cold-face tests, no linear correlation was found
between results of cardiovascular reflex tests and CD4 counts. Eight patients
(27%) obtained borderline Ewing-Clarke scores; 9 patients resulted affected by
early (6 pts, 20%) or intermediate (3 pts, 10%) stage of CAN. CONCLUSION: Signs of HIV-related
CAN are present in 30% of the African HIV+ patients observed, with no direct
correlation to their immunological status. Based on the relevance of the
problem and the presence of signs of CAN even in newly diagnosed and
treatment-naïve patients, the authors suggest that all HIV-patients should be
screened for the presence of the complication, in view of the possible serious
events associated with it.