A4: PROJ 2: AUTONOMIC FUNCTN IN HIV INFEC W/ ABDOMINAL ADIPOSITY RECEIVING HAART

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The widespread use of highly active antiretroviral therapy (HAART) has coincided with abnormalities of increased blood pressure, impaired glucose and lipid metabolism, insulin resistance, and increased abdominal adiposity. The constellations of these symptoms are characterized in human immunodeficiency virus- (HIV)-associated lipodystrophy syndrome and are independent risk factors for cardiovascular disease. We hypothesize that HAART and HIV infection induce HIV-associated lipodystrophy syndrome through a disturbance of the autonomic nervous system. Cardiovascular autonomic function testing (CAFT) is a non-invasive tool using an electrocardiogram and continuous blood pressure monitoring that can assess autonomic function. The objectives of our project are; (1) To characterize autonomic nervous system activity using CAFT in HIV-infected individuals receiving HAART compared to HIV negative controls, and to determine the correlation between CAFT with respect to the computerized tomography (CT) and dual-energy x-ray absorptiometry (DEXA) scans determined adipose accumulation, and (2) To determine the association between the mean autonomic deviation score and CD4 count, insulin resistance and fasting triglyceride. The significance of using CAFT in determining autonomic function differences in HIV-infected individuals is that it will aid in the understanding and potential treatment of HIV-associated metabolic abnormalities and HIV-associated lipodystrophy syndrome. Cardiovagal testing was performed on 66 participants: 28 HIV sero-negative controls, 20 HIV positive non-lipodystrophic (Non-LD) subjects, and 18 lipodystrophic (LD) subjects. After adjustment for visceral fat, time domain analysis showed decreased heart rate variability in subjects with LD compared to the other groups (p0.05). 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 0.05).