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Divisions of Neurology (Dr. Freeman) and General Medicine (Drs. Roberts and Friedman), the Arnold Center (Drs. Freeman and Friedman and Mr. Broadbridge), and the Autonomic Evaluation Unit (Drs. Freeman and Friedman and Mr. Broadbridge), New England Deaconess Hospital, and the Department of Neurology (Dr. Freeman), Beth Israel Hospital, Harvard Medical School, Boston, MA.
We compared autonomic function in 26 patients infected by the human immunodeficiency virus (HIV) (18 AIDS and 8 ARC) to 22 controls. A significant decline in autonomic function was present across groups. Autonomic dysfunction correlated strongly with signs of HIV-associated nervous system disease. We observed significant differences across groups in tests of heart rate variation (expiratory-inspiratory ratio, maximum minus minimum heart rate difference, and mean square successive difference), the mean arterial blood pressure fall to tilting, and the blood pressure response to isometric exercise. A trend of declining autonomic function from controls to AIDS was present in the 30:15 ratio, the Valsalva ratio, the systolic blood pressure fall to standing and tilt, and the cold pressor test. We did not observe any correlation between autonomic dysfunction and individual neurologic signs, prior therapeutic agents, and concurrent HIV-associated inflammatory or neoplastic processes. This study provides support for the presence of autonomic dysfunction in association with HIV infection. Autonomie dysfunction occurs more frequently and with greater severity in patients with AIDS; however, it may be present in the early stages of HIV infection and appears to progress during the illness.
Address correspondence and reprint requests to Dr. Roy Freeman, Division of Neurology, New England Deaconess Hospital, 110 Francis Street, Boston, MA 02215.
Supported in part by funding from the Arnold Center. Dr. Freeman is supported in part by Public Health Service grant # FD-H-000393-01. Dr. Roberts is supported by National Research Service award F32-HS000015 from the National Center for Health Services Research and Health Care Technology Assessment.
Presented in part at the 41st annual meeting of the American Academy of Neurology, Chicago, IL, April 1989.
Received May 12, 1989. Accepted for publication in final form September 6, 1989.
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