Background: Higher nocturnal heart rate and lower nocturnal heart rate variability (HRV) is associated with increased cardiovascular disease mortality. Longitudinal studies on nocturnal HRV in people living with HIV (PLWH) are lacking.

Methods: We conducted a one-year prospective cohort study of adult PLWH and HIV-uninfected community controls in north-western Tanzania. At enrollment, we collected data on cardiovascular risk factors and tested blood samples for hemoglobin, insulin, CD4 cell count and C-reactive protein. We measured nocturnal HRV and heart rate at baseline and first year follow-up. Mixed effect linear regression was used to determine predictors of lower HRV.

Results: Of the 111 enrolled participants (74 PLWH and 37 HIV-uninfected), 57.7% were female and the median age was 40 years. Over one year of follow-up, the average nocturnal heart rate was 4.5 beats/minute higher in PLWH (p=0.006). In the fully adjusted model (with age, sex, nocturnal heart rate and diabetes), average nocturnal HRV was 10.5 milliseconds lower in PLWH compared to HIV-uninfected adults (p=0.03). Unlike with nocturnal heart rate, nocturnal HRV did not improve after one year of ART in PLWH or HIV-uninfected (fully adjusted change = -2.5 milliseconds, p=0.45). Lower educational attainment, lesser pancreatic β-cell function and anemia were associated with higher HRV.

Conclusions: Nocturnal parasympathetic nervous system function was persistently lower in PLWH compared to HIV-uninfected even after antiretroviral therapy initiation. Improving nocturnal autonomic nervous system function could be a target for cardiovascular disease prevention in PLWH.