Physiotherapy Management of HIV/AIDS

With recent advancements in medication, HIV/AIDS sufferers in developed countries are living longer (Palella et al., 1998) and as a consequence there is a growth in the number of people with chronic health conditions, musculoskeletal problems and physical disabilities (O’Brien et al., 2004) associated with AIDS. These trends all contribute to the growing demand for physiotherapy management of AIDS.

Most physiotherapy treatments for people with AIDS involve managing their pain, treating related musculoskeletal problems, peripheral neuropathies, general rehabilitation (Galantino & McReynolds, 1995) and health education (Useh, Akinpelu, & Makinde, 2003). However all treatments will be specific to the AIDS-defining illness that a patient presents.


Figure 1. Physiotherapist treating a malnourished child (IHI, 2005).

Physiotherapists may prescribe exercise programs to manage some of the chronic health conditions that may occur as a result of AIDS. Conditions include type 2 diabetes (associated with ART), insulin resistance, elevated blood triglycerides (Gale, 2003) and unwanted changes in weight and body composition (O’Brien et al, 2004).

Aerobic exercise improves cardiovascular fitness and mental well being while resistive exercise training increases muscle mass, strength and body weight in HIV/AIDS sufferers (O’Brien et al., 2005). Despite these positives, aerobic or/and weights training has no effect on immune status, CD4 count and/or viral load (O’Brien et al., 2004; O’Brien et al., 2008) and therefore exercise can only be used to manage HIV/AIDS rather than to reverse or stop its progression. High quality evidence suggest that 20 minutes of aerobic exercise three times a week for four weeks may be safe and may improve fitness and well being for adults living with HIV/AIDS (O’Brien et al., 2005), however as yet there exist no clear or definite exercise guidelines for AIDS sufferers.

Ultimately physiotherapy treatment can provide relief and improve functional ability, independence and quality of life in AIDS patients.

Figure 1. Illustrates areas of brain tissue loss in AIDS sufferers (Thompson et al., 2005). Recent research found that one of the main areas of brain damage in AIDS suffers if the motor cortex (are of brain that controls movement). This explains the presentation of abnormal gait in many poeple with AIDS. Physiotherapy treatment is essential to regain normal movement control and function.

Some musculoskeletal conditions that can arise from HIV infection:

Inflammatory Arthropathies:

• Arthralgia
• Acute Symmetric Polyarthritis
• Hypertrophic Osteoarthropathy
• Reiter Syndrome
• Psoriatic Arthritis
• HIV-Associated Arthritis
• Osteonecrosis

Myopathies:

• Pyomyositis
• Pyomyositis
• Zidovudine Myopathy

Infections:

• Septic Arthritis
• Tuberculosis Osteomyelitis
• Bacillary angiomatosis

Neoplastic (tumorous) Condition:

• Non-Hodgkins Lymphoma

Many of the above conditions can be managed with appropriate physiotherapy treatment.