Physiotherapy management of HIV AIDS

Physiotherapy management of  HIV AIDS Patients

What is HIV? What are the effect on immune system ?

The human immunodeficiency virus (HIV) damage or destroy the cells of immune system, it leads to compromise the functions of immune system. “Immune deficiency" occurs because of progressive deterioration of the immune system by HIV Infection. This weakened immune system is not able to fight against infection and disease.

What is AIDS?

Acquired immunodeficiency syndrome (AIDS) is a term which used to the most advanced stages of HIV infection.

How is HIV transmitted?

HIV can be transmitted through

Unprotected sexual intercourse-

 (vaginal or anal), and oral sex with an infected person.

Blood transfusion-

transfusion of contaminated blood, blood product bodily fluids (as in drug abusers who share contaminated intravenous needles, surgical equipment or other sharp instruments.

Intrapartum or perinatally from mother to child –

It may also be transmitted between a mother and her infant during pregnancy, childbirth and breastfeeding.

Risk for HIV infection-

There is a definite, though small, extremely low occupational risk of infection for health care workers and laboratory personnel who work with HIV-infected specimens and infected health care worker to his or her pts through invasive procedures.

No risk of HIVinfection-

There is no evidence that the virus can be passed through casual or family contact or by insects such as mosquitoes.

What are the pathologicalChanges occurs in HIV?

HIV attaches itself to a CD4 cell and enters it and makes copies of itself inside the CD4 cell and goes on to damage and destroy the cell. New copies of HIV burst out of the CD4 cell and go off to find more cells to invade. If the number of CD4 cells (the CD4 count) is reduced, the immune system has fewer cells to help it defend the body from other organisms. This means you're at a greater risk of getting ill.

Historical Review

First case of HIV was diagnosed in United States in 1981.

In India 1986 first case was Diagnosed by Dr. Suniti Solomon and her student Dr. Sellapan Nirmala amongst the female sex workers in Chennai, Tamil Nadu.

Statistics

South africa 1^st with 6,300,000 population having aids According to 2013 report.

According to the UN Report-

India has the 3^rd largest number of people living with HIV

(NACO) National Aids Control Organisation estimation report of 2015 states that

Prevalence of Male - 0.30%

                      Female- 0.22%

Manipur has the highest prevalence (1.15%) of HIV

Importance of Physiotherapy in HIV AIDS–

• Human Immunodeficiency Virus (HIV) is a Retrovirus and a subfamily of Lentivirus. 
• The infection with the virus results in progressive deterioration of the immune system leading to immune deficiency.
• Physiotherapy plays a role in caring and treatment of people suffering from conditions related to HIV/AIDS worldwide.

Why Physiotherapy plays animportant role in all stages of HIV?

Because we provides-

• Patient Education -(Helping the patient to understand the disease)
• Exercise to maintain functions and movement
• Prevention -Prevent Secondary Complications
• Pain management- Decrease pain and muscle wasting
•  Functional Participation -Increase functional participation
•  Neurological Problem- Decrease anxiety and stress
•  Reduce lung complications- Facilitated  Lung Clearance

Changes During HIV AIDS

Effect on immune system

·       Fever, chills

·       Night sweats

·       Diarrhoea

·       Headache

·       Muscle ache

·       Joint Pain

·       Decrease in Appetite

Respiratory Changes are-

Respiratory Infections

·   The risk of colds, influenza, and pneumonia

· Complications like tuberculosis, pneumonia, and a disease called pneumocystis carinii pneumonia (PCP). 

PCP causes:
trouble breathing
cough
fever

Neurological changes 

• Meningitis-Meningitis fever headache inflammation of meninges
• Encephalitis-Encephalitis inflammation of brain tissue common cause viral infection
•  Anxiety and depression
•  Neuropathy
• Balance Disorders
•  Seizures
•   Dementia

     Skin conditions

o   Erythematous Maculopapular rash

o   Mucocutaneous Ulceration

o   Kaposi’s Sarcoma

     Signs and Symptoms

o   Fever

o   Pharyngitis

o   Lymphadenopathy

o   Headache

o   Lethargy

o   Anorexia

o   Nausea, Vomiting

o   Lethargy exhaustion

Investigations                 

·       ELISA Test

·       CD4+ T cells Count

·       Complete Blood Count- low red blood cells (anemia), low white blood cells (leukopenia) and low platelets (thrombocytopenia).

WBCs, or leukocytes, help prevent and fight infections. A normal count ranges from 4,000–11,000/mm3.

o   Platelet Count- Platelet 150000-440000cu/ml blood

·       Skin Test

AIDS prevention  of transmission program in health care settings 

Complication of AIDS on various systems

Medical Management

·       Neucleoside reverse transcriptase (RT) inhibitors

·       Non-neucleoside reverse transcriptase (NNRTIs)

·       Protease inhibitor

·       Highly Active Antiretroviral Therapy (HAART)

·       Zidovudine, also called AZT, ZDV, and azidothymidine, has the trade name Retrovir. Zidovudine was the first antiretroviral drug approved by the FDA for the treatment of HIV.

·       Didanosine, also called ddI, with the trade names Videx and Videx EC, was the second FDA-approved antiretroviral drug. It is an analog of adenosine.

·       Zalcitabine, also called ddC and dideoxycytidine, has the trade name Hivid. This drug has been discontinued by the manufacturer.

·       Stavudine, also called d4T, has trade names Zerit and Zerit XR.

·       Lamivudine, also called 3TC, has the trade name Zeffix and Epivir. It is approved for the treatment of both HIV and hepatitis B.

·       Abacavir, also called ABC, has the trade name Ziagen, is an analog of guanosine.

·       Emtricitabine, also called FTC, has the trade name Emtriva (formerly Coviracil). Structurally similar to lamivudine, it is approved for the treatment of HIV and undergoing clinical trials for hepatitis B.

·       Entecavir

Physiotherapy Intervention

ASYMPTOMATICSTAGE

v Proper Education program -Explain about the disease prevention program, explain about medication with its effect, complication of disease  for the patient and his family.

v Maintain the pulmonary system- Maintaining the pulmonary system by clearing chest secretions and expanding lung tissue if there is collapse

v Muscle wasting –Exercise program eg. Isometric exercises, active assisted movements, active movements.

v Postural Correction-Postural Correction exercises to prevent any deformities

v Balance  Training-

v Symptomatic Management for pain and  muscle wasting

v Increase strength, power, endurance of  cardiac and peripheral muscles - Performing progressive resistive exercise (PRE) or a combination of resistive and aerobic exercise aleast three times per week for at least six weeks is safe and can lead to improvements in cardiorespiratory fitness, strength, weight, and body composition for adults with HIV. Exercise may be considered a safe and beneficial for enhancing the health of medically stable adults aging with HIV.

SUB ACUTE STAGE

·       Continuation Of Care

·       Symptomatic Treatment and Secondary Disease Management

·  Maintain the normal joint ranges -Maintaining the normal joint ranges and increasing circulation to dependant limbs by doing passive mobilization

·     Provision of Assistive Device -Provision of Assistive Device

o   Early Symptomatic stage

·   Decrease Pain : Therapy depend on the variable presentation of patient

·    Include gait training, Balance Training, Lung Clearance and Endurance Training

·       Neurological Management

·       Motor skills Management

Policies for HIV Aids

·       National Aids Control Organisation (NACO) 1990-91

·       District Aids Prevention and Control Unit (DAPCU) 2007-12

·       Maharashtra State Aids Control Society (MSACS)

·  NACO: comprehensive programme for prevention and control of HIV/AIDS in India

·    District AIDS Prevention and Control Unit (DAPCU) is a district level decentralized monitoring unit of National AIDS Control Organisation in India. They have been established in 189^[1] high priority districts across the country as a step toward decentralization of the coordination and management of Government of India's National AIDS Control Programme, by working in close coordination with the district administration to take up district specific initiatives by leveraging local resources. DAPCUs have been trained and mentored to perform the challenging task of coordinating and monitoring of NACP activities Objectives of MSACS are:

·       To prevent HIV transmission and control its spread.

·       To reduce morbidity and mortality associated with HIV infection.

·       To reduce the adverse social and economic impact resulting from HIV infection.

·       To coordinate and strengthen STD/HIV/AIDS surveillance.

·   To provide technical support in HIV/AIDS prevention and control to Government and Non Government Organizations.

·   To develop health promotion interventions among high risk behavior groups.

·  To enhance the community awareness, specifically knowledge, Attitude and practice of high risk groups.

·                      To develop Health Education materials for distribution and adoption by         agencies working in AIDS prevention.

·                       To develop counseling services.

·                     To organize Social support for management of HIV infected and AIDS            patients.

·                    To monitor the development of HIV/AIDS epidemic in the state.

REFERENCES

1. Kshtrashal Singh  The role of Physiotherapy in AIDS Wasting SyndromeI, nternational Journal of Latest Research in Science and Technology Volume 1, Issue 1 : Page No. 85-88,May-June(2012).

2. Kelly K. O’Brien, Anne-Marie Tynan, Stephanie A. Nixonand Richard H. Glazier Effectiveness of Progressive Resistive Exercise (PRE) in the context of HIV:systematic review and meta-analysis usingthe Cochrane Collaboration protocol. BMC Infectious Diseases 17:268 (2017).

3. Soula Fillipas, Leonie B Oldmeadow, Michael J Bailey and Catherine L Cherry A six-month, supervised, aerobic and resistance exercise program improves self-efficacy in people with human immunodeficiency virus: A randomised controlled trial Australian Journal of Physiotherapy Vol. 52, 2006.

4. Rosemary Coates HIV infection and AIDS: A guide for physiotherapists Australian Journal of Physiotherapy36:17-21, 1990.

5. Jeanne M. Grace, Stuart J. Semple, Susan Combrink Jeanne M. Grace, Stuart J. Semple, Susan Combrink Journal of Exercise Science & Fitness 13 49-56 (2015).

6.  Sara D Pullen, Nnenna Nina Chigbo, Emmanuel Chukwudi Nwigwe, Chinwe J hukwuka, Christopher Chim Amah, Stanley C Idu,  Physiotherapy intervention as a complementary treatment for people living with HIV/AIDS HIV/AIDS – Research and Palliative Care 2014:6 99–107.

7. Harrisons Principles of Internal Medicine 17^th edition Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, Loscalzo.

8. Textbook of Pathology 6^th edition Harsh Mohan.

9. American College of Sports Medicine 5^th edition Lippincott Williams and Wilkins.

10. Text book of principal of medicine devidsion.