The heart rate variability changes in measles, HIV, and SARS-CoV-2 infections; a subtle autonomic involvement - a pilot study.

Introduction: Inflammation may induce dysautonomia, which is revealed by the decrease in heart rate variability (HRV) parameters. Our pilot study compares changes in HRV and the association between HRV and inflammatory markers in three RNA viral infections: acute (SARS-CoV-2, measles) and chronic (HIV). Methods: We evaluated 25 patients with viral infections and 8 control patients without viral disease, with similar mean age and comorbidities. Patients with measles and COVID-19 were hospitalized for mild to moderate respiratory symptoms, while those with HIV were assessed during follow-up visits. HRV parameters were assessed in time and spectral domains, under standardized conditions. Results: Significant differences were identified between patients with measles and COVID-19 regarding SDNN (p=0.016), rMSSD (p=0.002), and between patients with COVID-19 and HIV, both for SDNN (p=0.029) and rMSSD (p=0.017). SDNN and rMSSD had the highest value in the COVID-19 group and the lowest value (lower than in the control group) in patients with HIV and measles. All frequency-domain parameters reached their highest values in patients with COVID-19, whereas they were consistently lower in those with HIV and measles. A significant correlation of LF/HF ratio with serum fibrinogen was observed only in patients with measles and HIV infection (r=0.793, p=0.011, respectively r=0.955, p<0.001). Conclusions: Our study showed a significant decrease in HRV parameters in patients with measles and HIV, with a more stable autonomic response in mild-moderate COVID-19 forms. A correlation between inflammation and markers of sympathetic dominance was found in patients with measles and HIV but not in COVID-19. Further studies may assess the relation between inflammation in viral infections and subtle changes in HRV parameters.