Correlation of Cardiac Autonomic Dysfunction with CD4 Count in Human Immunodeficiency Virus Patients

ABSTRACT

Background: Almost all organs and systems in thebody are affected by Human Immunodeficiency Virus(HIV) infection. Autonomic nervous systeminvolvement and cardiac autonomic dysfunction isknown to affect severely the quality of life in HIVpatients due to fatal consequences in later stages of thedisease. Aim and Objectives: Assessment of cardiacautonomic dysfunction on HIV infection/AcquiredImmunodeficiency Disease Syndrome (AIDS)patients and to correlate the degree of dysfunction withCluster of Differentiation 4 (CD4) count. Material andMethods: Fifty one human HIV sero-positive patientswith 20 HIV sero-positive patients without AIDS and31 with AIDS and 51 controls were studied for cardiacautonomic dysfunction in a tertiary care medicalcollege hospital. The assessment of cardiac autonomicfunction was done by series of autonomic functiontests. The number of abnormal test results correlatedwith CD4 count. Results: In patients with HIV,abnormal cardiac autonomic functions were observedin 5.6% of patients without AIDS and 37.5% of patientswith AIDS. Significant differences between HIVpatients and controls was observed for systolic bloodpressure response to standing (p<0.001), diastolicblood pressure response to persistent handgrip(p<0.001), heart rate variability to standing (p<0.001),Valsalva maneuver (p<0.001) and to deep breathing(p=0.001). Abnormalities in cardiac autonomicfunction occurred at all levels of CD4 counts. Ourstudy showed an increase in incidence of cardiacautonomic dysfunction as the CD4 count decreased.Conclusion: The affection of various organs andsystems is a consequence of autonomic dysfunction inHIV infection and often invasive procedures arerequired for diagnostic and therapeutic decisions.When HIV patients present with symptoms likedizziness and headache which can be present in manyconditions, cardiac autonomic dysfunction should befirst ruled out by performing simple autonomicdysfunction tests before resource consumingexpensive and invasive tests were performed later onlyif needed.