Cardiovagal autonomic dysfunction in relation to HIV-associated lipodystrophy

Purpose: Human immunodeficiency virus (HIV)-associated lipodystrophy (LD) may be mediated by changes in the autonomic nervous system. We examined the autonomic function among HIV-infected patients with LD compared to HIV-infected patients without LD (non-LD) and HIV-negative controls (controls). Method: This cross-sectional study examined cardiovagal autonomic function among the three groups. LD was defined in HIV-infected patients as increased visceral adipose accumulation and peripheral lipoatrophy. Cardiovagal autonomic testing was assessed by measuring heart rate variability during rest, paced breathing, and upright tilt and was analyzed in time and frequency domains. Results: Cardiovagal testing was performed on 58 participants: 26 controls, 20 non-LD, and 12 LD. After adjustment for visceral fat, time domain analysis showed decreased heart rate variability in patients with LD compared to the other groups (p < .05). The frequency domain analysis showed decreased high-frequency power and increased low- to high-frequency power ratio in the LD group compared to both groups during rest and to non-LD during tilt (p < .05). Conclusion: Patients with LD have altered cardiovagal modulation. Patients with LD had lower heart rate variability and higher sympathetic modulation compared to non-LD and controls. These alterations may be prognostic of increased cardiovascular disease morbidity and mortality.