Physiotherapy Interventions in HIV

Original Editor - Niha Mulla

Top Contributors - Niha Mulla and Vidya Acharya  

Introduction[edit | edit source]

People living with HIV and AIDS present a new challenge to physiotherapists. The role of physiotherapists in HIV is becoming more apparent.[1] Physiotherapeutic interventions with exercises and manual therapy for people living with HIV is highly beneficial as physiotherapy plays a vital role in optimization of life. As HIV lead to AIDS, defense mechanism of the body fails step-by-step.

HIV patients have been living longer since past three decades as 50% of HIV patients have access to Antiretroviral Therapy. This means people with HIV are aging, leading to increased number of co-morbidities. As Antiretroviral Therapy adds valuable years to the life of these patients, it is vital to add life to these years via physical therapy and rehabilitation. Physical rehabilitation plays a major role in maintaining physical, mental and social health. [2][3]

This multi-system disorder affecting patients may require physiotherapy for various problems due to respiratory, neurological, musculoskeletal, and painful syndromes and a general decline in fitness and function. More chronic problems requiring physiotherapy are becoming evident with improved medical treatment and better prognoses.[1] For physiotherapists treating people HIV positive in many settings from maternity wards to out-patient departments, it is essential to have some knowledge of the virus to ensure confidence and safety in treating patients and avoid inappropriate reactions, which are, unfortunately, seen even in cases the hospital setting. Also, due to multi system pathology of the disease, most HIV/AIDS patients have prolonged hospital stays that raise the chances of complications like muscle wasting, joint stiffness, contractures, reduced lung capacities, pressure sores, early cardiopulmonary disorders along with diabetes, etc. which show beyond doubt that physiotherapy interventions are much needed. [4]

Rehabilitation with older/Aging HIV positive patients[edit | edit source]

People with HIV face many challenges as they age. Physical, social, and psychological consequences of the disease, long term treatment, and comorbidities, along with an uncertain future, is not easy to deal with, but rehabilitation can make it easier to deal with it as a whole..[5]

Common impairments and activity limitations[edit | edit source]

Some common day to day difficulties of older patients with HIV are as follows:[5]

  • Fatigue/weakness
  • Health uncertainty
  • Difficulties with daily living activities/ home chores
  • Difficulty being part of social life/ maintaining a job
  • Stress, Depression and anxiety leading from worrying about future life.
  • Early onset of cardiovascular disorders, diabetes, musculoskeletal and neurocognitive disorders..

Physiotherapy and rehabilitation assist in managing patients in long term care due to HIV. Therapy can be provided as inpatient care or outpatient care at clinic or at home.[6] It helps prevent, delay or cure complications. and lead an independent, pain free life. Each patient with HIV/AIDS needs to be assessed separately using HIV Disability Questionnaire as each patients can show different level of morbidities and comorbidities. [2][7]

Physiotherapy in acute stage[edit | edit source]

  1. Clear chest secretions[4]
  2. Eliminate shortness of breadth [3]
  3. Maintain and improve cardiopulmonary fitness [3]
  4. Maintain normal joint range of motion[4]
  5. Postural correction to avoid pain and deformities[4]
  6. Aerobic and resistive exercises to maintain functional health (medium to high intensity)[3][5][8]

Physiotherapy in chronic stage[edit | edit source]

  1. Strengthening and resistive exercises to prevent/cure muscle weakness and wasting[3]
  2. Improve neurological balance [3]
  3. Maintain circulation to the limbs with active and passive exercises and mobility training[4]
  4. Stretch to prevent contractures. [4]
  5. Pain Management[4]
  6. Independence of daily living activities[5]
  7. Improve pulmonary function[5]
  8. Aerobic training to maintain functional health at least 3 times each week (low intensity for longer duration) [3][5][8]
  9. Cognitive behavioral therapy to improve memory and functional status[5]

Benefits of physiotherapy, rehabilitation & exercise in patients with HIV[edit | edit source]

Research suggests that progressive resistance exercise (PRE) and moderate-intensity aerobic exercise (MIAE) have significant physiological and immunological benefits for people with HIV who are on antiretroviral drugs. A new study comparing the effects of 6 weeks progressive resistance exercise and moderate-intensity aerobic exercise on CD4 count and weight of people living with HIV/AIDS showed an increase in CD4 levels and weight gain[9]. The study recommends the following:

  1. Moderate-intensity aerobic exercise should be used as an adjunct therapy in managing people living with HIV/AIDS who are either on Highly Active Antiretroviral Therapy. It significantly boosts the immune system, improving absolute CD4 count.
  2. Exercise Physiologists and Health Managers should educate and encourage patients to engage in PRE, which will help in  targeting weight gain.[9]

References[edit | edit source]

  1. 1.0 1.1 McClure J. The role of physiotherapy in HIV and AIDS. Physiotherapy. 1993 Jun 10;79(6):388-93.
  2. 2.0 2.1 Brown D. HIV – what has physiotherapy and rehabilitation got to do with it? Physiospot. 2017 Available from: https://www.physiospot.com/opinion/hiv-what-has-physiotherapy-and-rehabilitation-got-to-do-with-it/#author
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Pullen SD, Chigbo NN, Nwigwe EC, Chukwuka CJ, Amah CC, Idu SC. Physiotherapy intervention as a complementary treatment for people living with HIV/AIDS. Hiv/aids (Auckland, NZ). 2014;6:99.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Simfukwe P. The role of physiotherapy in people living with HIV/AIDS. Health Department, Republic of South Africa. Available from: https://www.kznhealth.gov.za/physio_hivaids.pdf
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 O'Brien KK, Solomon P, Trentham B, MacLachlan D, MacDermid J, Tynan AM, Baxter L, Casey A, Chegwidden W, Robinson G, Tran T. Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis. BMJ open. 2014 May 1;4(5):e004692.
  6. Cobbing S, Hanass-Hancock J, Myezwa H. A home-based rehabilitation intervention for adults living with HIV: A randomized controlled trial. Journal of the Association of Nurses in AIDS Care. 2017 Jan 1;28(1):105-17.
  7. O’Brien KK, Solomon P, Bergin C, O’Dea S, Stratford P, Iku N, Bayoumi AM. Reliability and validity of a new HIV-specific questionnaire with adults living with HIV in Canada and Ireland: the HIV Disability Questionnaire (HDQ). Health and quality of life outcomes. 2015 Dec;13(1):1-1.
  8. 8.0 8.1 8.2 8.3 8.4 8.5 8.6 Jaggers JR, Hand GA. Health benefits of exercise for people living with HIV: A review of the literature. American journal of lifestyle medicine. 2016 May;10(3):184-92.
  9. 9.0 9.1 Asogwa EI, Abonyi OS, Elom CO, Oduma CA, Umoke CC, Ogai NA, Uwaleke CC, Nwimo IO. Comparative effects of 6-weeks progressive resistance exercise and moderate intensity aerobic exercise on CD4 count and weights of people living with HIV/AIDS in Alex-Ekwueme Federal University Teaching Hospital Ebonyi State. Medicine. 2022 Jan 14;101(2).