Acute Care in HIV

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Introduction[edit | edit source]

HIV infection is increasingly regarded as a chronic disease. As such, there is a high prevalence of disability among people living with HIV/AIDS (PLWHA). Although only a minority of rehabilitation professionals work with PLWHA, the rehabilitation professional community has the potential to play a greater role in addressing HIV/AIDS disability. The majority of PLWHA admitted to acute-care hospitals have at least one impairment, limited activities, and some level of participation restriction, requiring a physical therapist examination.[1] Acute care management of people with HIV infection requires a model of care that begins with comprehensive screening of a patient’s risk of morbidity and mortality. Rehabilitation professionals are uniquely suited to play an expanding and significant role in identifying and addressing the physical impairments and functional limitations of this population, thereby maximizing quality of life.[1]

Clinical signs of HIV infection[edit | edit source]

The most frequent signs and symptoms are[2]:

  • fever, headache, malaise, cough, and lymphadenopathy
  • Kaposi lesions (painless dark or purple lumps on skin or palate)
  • Severe bacterial infection—pneumonia or muscle infection
  • Tuberculosis—pulmonary or extrapulmonary
  • Oral thrush or oral hairy leukoplakia
  • Gum/mouth ulcers
  • Esophageal thrush
  • Weight loss more than 10 % without other explanation
  • Neurological involvement: including aseptic meningitis, encephalitis, and facial nerve paresis.

Diagnosis[edit | edit source]

People living with HIV should be diagnosed as soon as possible after contracting the virus, so that they can be connected to prevention and treatment services, and ART can be started.[2]

Screening Diagnostic Tests[edit | edit source]

The fourth generation immunoassays (IA) in primary HIV is used for screening diagnostic test, with sensitivity ranges from 99.7 to 100% and specificity ranges from 99 to 100%.

Confirmation Tests[edit | edit source]

After a positive screening test, a confirmation test is done.: a HIV-1/HIV-2 antibody differentiation assay (ADA) , a

Western blot (WB) or an immunoblot. In addition specimens which are reactive on the initial fourth-generation IA and nonreactive or indeterminate on the ADA proceed to HIV-1 NAT

Management[edit | edit source]

Physiotherapy management[edit | edit source]
  • Physiotherapists work with PLWHIV in acute care by early screening and management of disablement caused by the primary illness or any comorbid conditions.
  • preventions of impairments, activity limitations and participation restrictions.
  • Exercise: Aerobic and resistance training, especially in combination, is an effective rehabilitation technique for those with disabilities and poor health among PLWH.[3]

Resources[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 Kinirons SA, Do S. The acute care physical therapy HIV/AIDS patient population: A descriptive study. Journal of the International Association of Providers of AIDS Care (JIAPAC). 2015 Jan;14(1):53-63.
  2. 2.0 2.1 Henn A, Flateau C, Gallien S. Primary HIV infection: clinical presentation, testing, and treatment. Current infectious disease reports. 2017 Oct;19(10):1-0.
  3. Lau B, Sharma I, Manku S, Kobylianski J, Wong LY, Ibáñez-Carrasco F, Carusone SC, O’Brien KK. Considerations for Developing and Implementing an Online Community-Based Exercise Intervention for Adults Living with HIV: a qualitative study. medRxiv. 2021 Jan 1.