VAGAL SYSTEM IMPAIRMENT IN HUMAN IMMUNODEFICIENCY VIRUS-POSITIVE PATIENTS WITH CHRONIC HEPATITIS-C - DOES HEPATIC GLUTATHIONE DEFICIENCY HAVE A PATHOGENETIC ROLE

Background: Both an autonomic impairment and a systemic depletion of r educed glutathione (GSH) may be documented in patients with chronic li ver diseases and in human immunodeficiency virus (HIV)-positive patien ts. Methods: The coefficients of electrocardiographic R-R interval var iation (CVc) were assessed in 125 patients with chronic hepatitis C (C HC) (65 HIV-positive and 60 HIV-negative) and in 61 healthy controls. The CVc values were correlated with hepatic (H-GSH), plasmatic (P-GSH) , lymphocyte (L-GSH), and erythrocyte (E-GSH) concentrations of GSH an d with erythrocyte malondialdehyde (MDA) levels. Results: Compared wit h healthy controls, in CHC patients the concentrations of H-GSH, P-GSH , L-GSH, and E-GSH were reduced, whereas MDA levels were increased wit h a statistically significant difference (P < 0.001). CVc was signific antly reduced in patients with CHC (especially in those who were HIV-p ositive) and correlated significantly with the values of H-GSH, P-GSH, L-GSH, E-GSH, and MDA (P < 0.001). Conclusions: A dysfunction of the cardiac vagal system may be detected in patients with CHC (especially in those who are HIV-positive); this abnormality may be related to a r educed response to oxidative stress because of a systemic depletion of GSH.