Autonomic neuropathy in patients with HIV: course, impact of disease stage, and medication

Clin Auton Res. 2000 Feb;10(1):17-22. doi: 10.1007/BF02291385.


The purpose of this article is to examine the prevalence, degree, and natural course of pupillary neuropathy (PANP), cardiovascular autonomic neuropathy (CANP), and sensorimotor neuropathy (SNP) and to study the impact of disease stage and medication on neuropathy in 61 consecutive patients with HIV. PANP, CANP, and SNP were assessed by standardized test procedures. Overall prevalence of PANP, CANP, and SNP were 66%, 15%, and 15%, respectively. The maximal pupillary area (pupillary measure, p <0.0001) and the lying-to-standing ratio (cardiovascular measure, p <0.0001) were abnormal as compared with control subjects. The changes in CD4+ T-lymphocytes and respiratory sinus arrhythmia percentile during 2 years of follow-up correlated significantly (r = 0.758, p = 0.007). Patients with CANP were more often in an advanced disease stage than patients without CANP (p = 0.004). SNP, but not PANP or CANP, was associated with the intake of the neuropathogenic drugs dideoxycytidine, dideoxyinosine, and 2',3' didehydro-2',3' dideoxythymidine (p <0.05). Autonomic and sensorimotor neuropathy are frequent in patients with HIV, and progression of CANP may put patients at risk for unexpected cardiorespiratory arrest.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-HIV Agents / therapeutic use
  • Autonomic Nervous System Diseases / drug therapy
  • Autonomic Nervous System Diseases / epidemiology
  • Autonomic Nervous System Diseases / etiology*
  • Autonomic Nervous System Diseases / physiopathology
  • Brain Diseases / etiology
  • Brain Diseases / physiopathology
  • Cardiovascular System / innervation
  • Didanosine / therapeutic use
  • Female
  • Follow-Up Studies
  • HIV Infections / complications*
  • Humans
  • Iris Diseases / epidemiology
  • Male
  • Middle Aged
  • Movement
  • Prevalence
  • Sensation
  • Stavudine / therapeutic use
  • Zalcitabine / therapeutic use


  • Anti-HIV Agents
  • Zalcitabine
  • Stavudine
  • Didanosine