A meta-analysis of HIV and heart rate variability in the era of antiretroviral therapy.

Abstract

Heart rate variability (HRV) has been used to assess autonomic dysfunction since the beginning of the HIV epidemic. Although autonomic failure was commonly detected in HIV and AIDS patients prior to the advent of antiretroviral therapy (ART), the effect of HIV on HRV in the current era of widespread ART availability is more ambiguous. A systematic search and review was conducted on cross-sectional observational and case-control studies published in the era of ART (1996-2015) that compared HRV between HIV+individuals treated with ART and HIV-controls. Eight out of the 20 studies identified, enrolling a total of 292 HIV+adults (mean age 38.7years) and 201 HIV seronegative controls (mean age 35.1years), were included in a meta-analysis based on stringent methodological criteria. At rest, individuals with HIV showed lower HRV in the time (g)=-0.72, 95% CI (-1.03 to -0.42) and low-frequency (LF) domain (g)=-0.51, (-0.81 to -0.21); markers of lower parasympathetic tone in the time (g)=-0.55, (-0.85 to -0.25) and high-frequency (HF) domain (g)=-0.42, (-0.71 to -0.12); and higher LF:HF ratio (g)=0.46, (0.12-0.86) in the frequency domain, suggestive of parasympathetic withdrawal. This meta-analysis confirmed, within a relatively young cohort of HIV+adults on ART, a general reduction in autonomic function with a shift toward sympathetic dominance. This shift may predispose HIV patients to early and elevated risk of arrhythmias, cardiac events, and accelerated HIV disease progression.