Human Immunodeficiency Virus-Associated Autonomic Neuropathy, Drug Addiction, and Zidovudine Treatment

We would like to make some comments on the work by Rüttimann et al¹ on human immunodeficiency virus (HIV)—associated autonomic neuropathy, which we read with interest. In a group of HIV-positive intravenous drug users,² we found that 59.4% of the subjects without neurologic symptoms were showing dysfunction of the autonomic nervous system (ANS) to the same cardiovascular tests mentioned by Rüttimann et al. Also, we have found that more severe ANS involvement is related to the seriousness of the disease (Centers for Disease Control groups). The observation of higher values of circulating immune complex in subjects with more important ANS involvement seems to us a valid support for the hypothesis of an autoimmune pathogenesis of the autonomic neuropathy.

In the "Conclusions" section of one of our articles,³ we described a subject with acquired immunodeficiency syndrome—dementia complex that manifested a relevant improvement to the ANS functional test response