Autonomic nervous system dysfunction associated with HIV infection in intravenous heroin users

Villa, Antonio; Foresti, Valeriano; Confalonieri, Franco

doi:10.1097/00002030-199201000-00011

Cited by 43 publications

(11 citation statements)

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“…Autonomic neuropathy seems to be clinically important in the advanced stages of HIV disease, occurring in at least 12% of patients. 75 It is usually found in conjunction with DSPN. Postural hypotension and gastroparesis are the most common manifestations.…”

Section: Distal Symmetrical Sensory Polyneuropathy (Dspn)mentioning

confidence: 99%

The peripheral nerve complications of human immunodeficiency virus (HIV) infection

Brew

2003

Muscle and Nerve

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Peripheral nerve complications occurring in patients with human immunodeficiency virus (HIV) infection are frequent and challenging. This review discusses these various complications according to the degree of advancement of HIV disease. Particular emphasis is placed upon emerging causes of neuropathy found in the context of HIV disease, such as infection with hepatitis C and human T-lymphotropic virus type I, as well as neuropathies related to antiretroviral medications.

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Section: Distal Symmetrical Sensory Polyneuropathy (Dspn)mentioning

confidence: 99%

The peripheral nerve complications of human immunodeficiency virus (HIV) infection

Brew

2003

Muscle and Nerve

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“…Studies from early in the AIDS epidemic, prior to the widespread use of CART, suggested that autonomic dysfunction was an important neurologic complication of HIV (Craddock et al 1987; Freeman et al 1990; Cohen and Laudenslager 1989; Ruttimann et al 1991; Villa et al 1992; Villa et al 1995). However these studies were small, ranging from five to 57 HIV-infected participants, medication use that could mimic autonomic phenomena was typically not addressed, and in all but one (Freeman et al 1990), autonomic testing was performed in isolation.…”

Section: Introductionmentioning

confidence: 99%

Autonomic dysfunction is common in HIV and associated with distal symmetric polyneuropathy

et al. 2013

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Neurologic complications of HIV are well characterized in the central and peripheral nervous systems but not in the autonomic nervous system, perhaps due to the complexities of measuring autonomic function in medically ill populations. We hypothesized that autonomic dysfunction is common in HIV, can be meaningfully measured with an autonomic reflex screen, and is associated with distal symmetric polyneuropathy (DSP) but not with signs of CNS disease. We also sought to characterize immuno-virologic and medical factors associated with autonomic dysfunction. We assessed 102 HIV-infected adults for autonomic dysfunction with a laboratory-based autonomic reflex screen summarized as the Composite Autonomic Severity Score (CASS). The Total Neuropathy Score (TNS) was used to quantify DSP based on neurologic interview/examination, quantitative sensory testing, and nerve conduction studies. Autonomic dysfunction was common, with a CASS ≥ 3 in 61% of participants, of whom 86% were symptomatic. Greater CASS abnormalities demonstrated univariate association with increasing TNS, age, viral load, hypertension, and use of medications (particularly anticholinergics), but not with antiretrovirals, current/nadir CD4+ count, HIV-duration, metabolic factors, or signs of CNS disease. The TNS was the only significant predictor of the CASS in multivariate analysis; anticholinergic medications were marginally significant. This study demonstrates that autonomic dysfunction is common and frequently symptomatic in HIV, and that an autonomic reflex screen, adjusted for anticholinergic medication, is useful in its assessment. Association of autonomic dysfunction with DSP suggests common factors in their pathogenesis, and autonomic neuropathy may be part of the spectrum of HIV-associated peripheral nerve pathologies.

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“…Unexpected cardiorespiratory arrest has demonstrated the lifethreatening potency of CANP in patients with HIV [10,11 ]. In cross-sectional studies, prevalence of CANP was reported as 5% to 70%, depending on the definition of autonomic neuropathy [3,[11][12][13][14][15][16][17][18][19][20]. However, little is known about other forms of autonomic neuropathy such as pupillaty autonomic neuropathy (PANP), the influence of anti-HIV medication on autonomic neuropathy, or the natural course of CANP or PANP.…”

mentioning

confidence: 99%

Autonomic neuropathy in patients with HIV: Course, impact of disease stage, and medication

Glück

Degenhardt

Schölmerich

et al. 2000

Clinical Autonomic Research

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The purpose of this article is to examine the prevalence, degree, and natural course of pupillary neuropathy (PANP), cardiovascular autonomic neuropathy (CANP), and sensorimotor neuropathy (SNP) and to study the impact of disease stage and medication on neuropathy in 61 consecutive patients with HIV. PANP, CANP, and SNP were assessed by standardized test procedures. Overall prevalence of PANP, CANP, and SNP were 66%, 15%, and 15%, respectively. The maximal pupillary area (pupillary measure, p <0.0001) and the lying-to-standing ratio (cardiovascular measure, p <0.0001) were abnormal as compared with control subjects. The changes in CD4+ T-lymphocytes and respiratory sinus arrhythmia percentile during 2 years of follow-up correlated significantly (r = 0.758, p = 0.007). Patients with CANP were more often in an advanced disease stage than patients without CANP (p = 0.004). SNP, but not PANP or CANP, was associated with the intake of the neuropathogenic drugs dideoxycytidine, dideoxyinosine, and 2',3' didehydro-2',3' dideoxythymidine (p <0.05). Autonomic and sensorimotor neuropathy are frequent in patients with HIV, and progression of CANP may put patients at risk for unexpected cardiorespiratory arrest.

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Autonomic nervous system dysfunction associated with HIV infection in intravenous heroin users

Cited by 43 publications

References 0 publications

The peripheral nerve complications of human immunodeficiency virus (HIV) infection

The peripheral nerve complications of human immunodeficiency virus (HIV) infection

Autonomic dysfunction is common in HIV and associated with distal symmetric polyneuropathy

Autonomic neuropathy in patients with HIV: Course, impact of disease stage, and medication

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