Academic journal article Journal of Allied Health

Physical Therapy as an Adjunct Treatment for People Living with HIV/AIDS: An Allied Health Perspective

Academic journal article Journal of Allied Health

Physical Therapy as an Adjunct Treatment for People Living with HIV/AIDS: An Allied Health Perspective

Article excerpt

Amy Tsoumas, DPT With the increased life expectancy for people living with HIV/AIDS (PLWHA) has come chronic HIV-related impairments, many of which can be successfully treated by physical therapy (PT). The purpose of this study is to determine common HIV-related impairments that merit PT, HIV providers' PT referral patterns and patients' barriers to care. 57 surveys were distributed to HIV providers in Atlanta, Georgia. Results showed that providers typically referred to PT for musculoskeletal conditions, neurological conditions and pain control. Financial issues and lack of insurance were the most common barriers to PT care. This study concluded that there is a need for PT services amongst PLWHA and that financial limitations are a significant treatment barrier for PLWHA. J Allied Health

THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) and acquired immunodeficiency syndrome (AIDS) have shown significant changes in the past 20 years. There has been a noteworthy rise in the prevalence of people living with AIDS and increased rates of HIV infection as well as demographic changes in groups affected by HIV.1 Since the advent of highly active anti-retroviral therapy (HAART) in 1996, treatment of people living with HIV/AIDS (PLWHA) has changed significantly. PLWHA in developed countries have a nearly normal life expectancy when given access to adequate treatment.2 However, data show that a significant symptom burden continues to exist among persons with HIV/ AIDS.3 As PLWHA live longer lives, there will be increasing need for allied health involvement in their care. Given the changing needs of PLWHA, physicians must collaborate with allied health professionals in order to meet the diverse needs of this population. Physical therapy is especially important to identify and treat HIV-related physical impairments and to prevent further disability.

Atlanta, Georgia, is of particular interest in the HIV/ AIDS medical community due to the staggering increase in reported cases of infection. The prevalence of HIV infection in Atlanta is 1.34%, which the World Health Organization (WHO) characterizes as a "generalized epidemic," a term designating places where HIV infections have a prevalence of over 1%.4 The prevalence of high poverty rates, a large populations of African Americans and of men having sex with men (MSM), and intravenous drug use within metro Atlanta are contributingfactors conducive to increased HIV exposure.4

Common impairments of PLWHA include chronic pain, neurological deficits, and musculoskeletal impairments.

The most common neurological complication of HIV infection is peripheral neuropathy, which often correlates with chronic pain.3 In addition, other neurological disorders can lead to various symptoms such as slowed movement, ataxia, impaired gait, diminished fine motor skills and various cognitive impairments. Non-infectious musculoskeletal complications are estimated to affect about 72% of the HIV-infected population.5 Common complications include osteopenia/ osteoporosis, osteonecrosis, joint disease, myopathies, and metabolic disorders.6-8 HIV infection is also associated with lean body mass loss, which may be related to difficulty exercising, poor nutrition, and/or diffuse widespread pain, metabolic disturbances, and lipid abnormalities.9,10 These physical manifestations contribute to sedentary behaviors, chronic pain, and decreased quality of life. Basavari et al.11 (2010) reported that the constellations of HIV-related symptoms negatively affect the quality of life (QOL) in PLWHA.

Physical therapy (PT) has been shown to positively affect the physical impairments, functional limitations, and QOL issues in a wide array of patient populations with various diagnoses.12,13 However, current literature lacks current, well-designed controlled studies regarding the role of PT specifically in the treatment of PLWHA. The limited research available is largely in case-report and qualitative design, which lacks validity and the ability to generalize results to the HIV/AIDS population indicating that future research in this area is both warranted and necessary. …

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