Association of virological control and antiretroviral therapy with a cardiovascular autonomic balance in HIV

Abstract

Autonomic dysfunction is reported in Human Immunodeficiency Virus (HIV) patients, leading to higher rates of morbity-mortality. However, the relationship of the viral load and antiretroviral therapy (ART) with the cardiovascular autonomic balance requires more clarification. The objective of the study was to evaluate the influence of ART and viral control concerning the autonomic balance and cardiovascular risks in HIV people. This was a cross-sectional study with 60 HIV patients, subdivided in three groups paired up by gender and age: with ART and undetectable viral load (ARTVL-; n=20); ART and detectable viral load (ARTVL+; n=20); and without ART and detectable viral load (noARTVL+; n=20). The cardiovascular autonomic control of heart rate variability (HRV) was evaluated according to time and frequency domain. The Framingham Risk Score was used in order to calculate the risk of cardiovascular events. It was observed that the viral load was lower in ARTVL+ than noARTVL+. The noARTVL+ demonstrated more lower frequency components (LF: 44.4±17.2nu; p<0.01) and less high frequency components (HF: 55.6±17.1nu; p<0.01) compared to ARTVL- (LF: 27.7±16.2nu; HF: 72.3±16.2nu) and ARTVL+ (LF: 27.2±14nu; HF: 72.6±14nu).There was a greater LF/HF ratio in the noARTVL+ (0.82 (0.46-1.42)) than in the ARTVL- (0.32 (0.18-0.60); p<0.01) and ARTVL+(0.31(0.23-0.61); p<0.01). The Framingham Risk Score did not differ among groups. It was concluded that HIV patients who did not use ART showed greater sympathetic activity, lower parasympathetic response, and damage in the autonomic balance when compared to the ART groups.