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MINERVA CARDIOANGIOLOGICA

A Journal on Heart and Vascular Diseases


Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2008 August;56(4):417-28

language: English

Cardiovascular autonomic neuropathy in HIV-positive African patients

Compostella C. 1, Compostella L. 2, D’Elia R. 1

1 Institute of Infectious Diseases University of Padua, Padua, Italy
2( former) Day Hospital for HIV/AIDS Health Centre of Homoine, Inhambane/Mozambique


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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.

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