Due to advances in medications, people with human immunodeficiency virus (HIV) are living longer and leading more active lives than people who had the disease 30 years ago. Antiretroviral drugs allow many people with HIV to live out their natural lifespan, but sometimes the medication side effects, or just living with HIV for many years, can lead to common health problems such as peripheral neuropathy, muscle ache and pain (myalgia), hypertension, and high blood sugar (hyperglycemia). Further, people with HIV have the same problems that anyone else might have, such as sports related injuries, or age related conditions such as arthritis.
Physical therapists play an important role in treating conditions that limit movement and function and often are helpful in adapting treatments for other health conditions in consideration of the effects of HIV and any side effects of medications. They are particularly effective in providing custom exercise and pain management programs while helping people with advanced HIV prevent, reduce, and delay movement and functional problems.
The goal of every physical therapy program is to improve quality of life and keep people active in their home, at work and in the community. A thorough physical therapy evaluation will help identify the causes of pain, difficulty with movement, and physical activity. This will lead to a comprehensive treatment plan to address the patient’s goals. Physical therapy programs for the HIV patient generally address four areas of need: weakness and fatigue, nerve pain or peripheral neuropathy, balance and fall prevention, and aerobic conditioning.
In terms of muscle weakness, long-term infection and certain treatments often can result in loss of muscle strength, lean body mass, and muscle bulk. This results in feelings of fatigue, or lack of energy which has been found to be the most common debilitating complaint of HIV-infected people. A well designed low-to-moderate intensity resistance program, adjusted over time for strength gains, has been shown to achieve considerable strength improvements and increase lean body mass.
Peripheral neuropathy is also a common complaint of persons living with HIV which may include muscle pain, burning sensations, numbness, tingling, cramps, and spasms. Physical therapists design programs to stretch tight muscles, strengthen weak ones, and incorporate manual therapy to reduce pain around joints and tender trigger points in a particular muscle or muscle group. Night splints have also been found to be effective.
Advanced HIV Issues
People with advanced HIV often have problems with balance and walking. This can be related to opportunistic infections that involve the brain or nerves, weakness, lack of flexibility, poor posture, or problems with sensory organization/integration. Physical therapists are experts in determining the many combinations of issues that lead to balance deficits and providing comprehensive programs of strengthening, gait training, and specific balance exercises to address these issues.
Finally, heart health or aerobic conditioning plays a part in the physical therapy program of the HIV patient. Research has suggested that some of the new drugs used in HIV may add unwanted body fat, and living longer may also add age-related weight gain. A well designed aerobic exercise program can help maintain a healthy body weight, improve energy levels, and help the immune system work more efficiently.
Physical therapists play an important role in helping those with HIV stay active and moving, and improve their quality of life. Patients often share a longstanding relationship with their physical therapist as they are effectively providing a physical therapy program addressing a short term episodic need as well as a comprehensive program for long term issues. Physical therapy is covered by most insurance programs and a physician referral is required.