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

Abstract

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.

Cardiovascular complications in the acquired immunodeficiency syndrome

“…There is evidence of an altered autonomic function in HIVinfected patients 27,28 .In a previous study, autonomic dysfunction in HIV-infected patients was assessed by a significant decrease of the corrected coefficients of electrocardiographic R-R interval variation (CVc) compared to healthy controls 29 . CVc correlated significantly with CD4 count and with values of hepatic, plasmatic, lymphocyte and erythrocyte concentrations of reduced glutathione as well as with erythrocyte malonyldialdehyde levels as the expression of increased lipoperoxidation 29 .…”

Cardiac Involvement in Peripheral Neuropathies

“…The prevalence of CAN in HIV-associated neuropathy shows great variability between 5% and 77% in the literature. 12,59,60 The discrepancy between the studies is related to the definition of autonomic dysfunction and heterogenicity of the population studied. 11,12,59 The QTc interval was measured to correlate the degree of autonomic neuropathy.…”

“…25 As patients with prolonged QTc interval have more risk to develop life-threatening ventricular arrhythmia, these patients should be followed closely because of increased risk of sudden death. 13,25,59,60 HIV-positive patients can show a significantly lower HRV than the healthy population and can show sympathovagal balance alteration. 11,12,59 CAN can be seen at the early stage of AIDS, but CAN is worse and more frequent in advance stages of the disease.…”

“…CAN is more frequently seen in HIV-infected patients with lower CD4+ T-lymphocyte counts. 11,[58][59][60] In patients with CAN, medications and anesthetic agents that may increase risk of arrhythmia should be selected and used very cautiously. Several medications commonly used in treatment of HIV can be neurotoxic and may cause some of the abnormalities in autonomic testing.…”

Modulating effect of respiration on atrioventricular conduction time assessed using PR interval variation

“…The degree of RSA is influenced by several factors, including age, respiration rate, tidal volume and a range of pathophysiologies (STRAUSS-BLASCHE et al, 2000;HRUSHESKY et al, 1984). The assessment of RSA has found clinical use as a measure of cardiac health in a variety of settings (SCHULTE et al, 2001;GLUCK et al, 2000;CASADEI et al, 1996).…”