Autonomic Neuropathy in HIV is Unrecognized and Associated with Medical Morbidity

Abstract

Autonomic dysfunction is common in HIV. However, its clinical impact is not well understood and its protean symptoms make it difficult to diagnose. We sought to determine: (1) whether autonomic neuropathy is associated with morbidity and predicted mortality in HIV as measured by the Veterans Aging Cohort Study (VACS) index; and (2) if healthcare providers recognize the diagnosis of autonomic neuropathy. Data were obtained from 102 HIVinfected adults enrolled in a prevalence study of autonomic dysfunction from 2011-2012. Participants were predominantly minority with nearly equal numbers of men and women. Most were receiving an antiretroviral regimen with a nucleoside reverse transcriptase inhibitor backbone and a base of a non-nucleoside reverse transcriptase inhibitor, protease inhibitor, or integrase inhibitor. Autonomic neuropathy was defined using a laboratory-based autonomic assessment, the Composite Autonomic Severity Score (CASS). Medical records were reviewed for the year prior to the autonomic assessment. We found that the autonomic neuropathy score (CASS) was associated with the VACS index. We also found that among 53 participants with symptomatic autonomic neuropathy, the diagnosis had been considered for only one. The majority of the symptoms were either unexplained or attributed to medication side effects. This study demonstrates that autonomic neuropathy in HIV is associated with serious co-morbid illnesses known to increase mortality risk, and that HIV healthcare providers rarely consider autonomic neuropathy in their differential diagnoses. Future studies are needed to determine if autonomic neuropathy is an independent risk factor for mortality in HIV, and to raise awareness of its signs and symptoms.

HIV-related neuropathy: current perspectives

“…Recent studies suggest that autonomic neuropathy is a common comorbidity of HIV DSP, affecting more than half of all HIV DSP patients and is associated with predictors of mortality as summarized by the Veterans Aging Cohort Study Index 100,115,116…”

The α7‐nicotinic receptor is upregulated in immune cells from HIV‐seropositive women: consequences to the cholinergic anti‐inflammatory response

“…Although the importance of the CAP in several disease states has been recently established, 11 , 12 , 13 the CAP has not been investigated in the inflammatory scenario of HIV infection. Several lines of evidence suggest that the cholinergic anti‐inflammatory response (dependent on vagus nerve integrity) could be compromised by HIV infection because infected subjects exhibit hyperactivity of the sympathetic autonomic nervous system or reduction in parasympathetic activity, both at rest and during postexercise recovery, 14 and autonomic dysfunction is also common in HIV‐infected patients being associated with serious comorbid illnesses known to increase mortality risk 15 , 16 . The α7 nicotinic acetylcholine receptor (α7) is a homooligomeric nicotinic acetylcholine (ACh) receptor that is abundantly expressed in the central nervous system.…”

The Quantitative Analgesic Questionnaire: A Tool to Capture Patient-Reported Chronic Pain Medication Use

“…The retrospective group ( n =115) was enrolled in a study of HIV-associated neuropathy as previously described, 14, 15 and the prospective group was enrolled in a study of Mindfulness-Based Stress Reduction (MBSR) for the treatment of chronic neuropathic and musculoskeletal pain in HIV ( n =34), the results of which have not yet been published. All procedures were performed in accordance with a protocol approved by the institutional review board of the Icahn School of Medicine at Mount Sinai, all participants gave written informed consent.…”