HIV Diseases and AIDS

Today, due to advances in medications, people with HIV (human immunodeficiency virus) disease are living longer and leading more active lives than people who had the disease 30 years ago. Antiretroviral drugs allow many people with HIV disease to live out their natural lifespan, but some of the drugs have side effects. In addition, as people live longer with the disease, they may develop other health conditions, too. Physical therapists:

  • Tailor treatments that take HIV disease into account
  • Provide customized exercise and pain management programs
  • Help people with advanced HIV disease prevent, reduce, or delay movement and function problems

What is HIV Disease and AIDS?

HIV disease is due to infection with HIV, a retrovirus. Commonly, HIV is passed on through sexual relations with an infected person, exposure to contaminated blood, or from mother to child during pregnancy, childbirth, or breastfeeding. Most people with HIV disease get the virus through unprotected sex or through intravenous drug use. Following an acute infection, people who are untreated will progress from having no symptoms to having advanced HIV disease, or acquired immunodeficiency syndrome (AIDS). This may take several months or years. Advanced HIV disease, or AIDS, is a life-threatening condition because it interferes with the immune system. As a result, the body is less able to fight off infections. These “opportunistic” infections are the leading cause of death in untreated HIV disease.

AIDS is diagnosed by your physician using a series of blood tests. Many community-based screening centers offer low-cost HIV tests. A screening test for HIV antibodies usually involves a few drops of blood taken from the finger or a swab inside the mouth, and test results are known within minutes.

Signs and Symptoms

Following acute infection with HIV, you might develop flu-like symptoms (fever, headache, sore throat, swollen glands, rash) for a period of days or weeks—or you may have no symptoms at all. After about 3 weeks, an HIV antibody test will show that you are HIV positive. Even when you’re HIV positive, you might remain completely symptom free for years. If untreated, however, the disease will progress, and you will begin to have such symptoms as:

  • Swollen lymph nodes
  • Diarrhea
  • Weight loss
  • Fever
  • Night sweats
  • Cough or shortness of breath

If untreated, advanced disease, or AIDS, usually develops within 10 years. Advanced disease makes you more prone to get opportunistic infections. Symptoms may include:

  • Night sweats
  • Chills
  • Cough
  • Chronic diarrhea
  • White spots or lesions on the tongue or in the mouth
  • Skin rashes
  • Headaches
  • Fatigue
  • Weight loss
  • Cognitive changes, such as confusion or forgetfulness
  • Blurred and distorted vision

Advanced disease also can lead to chronic pain and reduced ability to do work or recreational activities, and this is where your physical therapist can help most.

People who are successfully treated with antiretroviral drugs do not usually get opportunistic infections, but sometimes the side effects of some of the drugs—or simply having HIV disease for a long time–can lead to health problems. For instance, you might develop:

  • Peripheral neuropathy, which is nerve damage that results in pain, burning sensations, and numbness or tingling in your arms or legs
  • Muscle ache and pain (myalgia)
  • High blood pressure (hypertension)
  • High blood sugar (hyperglycemia)

A diagnosis of HIV disease might complicate your treatment for other health conditions. Common conditions, injuries, or other problems related to aging might affect long-term survival, especially in cases of advanced HIV disease.

How Can a Physical Therapist Help?

Although physical therapists do not treat the disease directly (that is done by an infectious disease specialist), they play an important role in treating conditions that limit your movement and function. Your therapist’s overall goal is to improve your quality of life and help you keep active in your roles at home, at work, and in the community.

People with HIV disease have many of the same problems that anyone else might have, such as sports injuries or age-related conditions like arthritis. In addition, you might have problems caused by the HIV disease, opportunistic infections, or the side effects of your medications. Your physical therapist will perform a thorough evaluation to identify the causes of your pain or your difficulty with movement and physical activity. Your therapist then will select from a number of treatments to help you improve your ability to do daily activities, your heart health, your balance, and your pain.

Improve Your Ability to Do Daily Activities

Long-term infection and certain treatments can result in the loss of muscle strength and muscle bulk (myopathy). This can make you feel tired and make it difficult for you to do the things you want to do. Research shows that exercise using weights is effective in increasing strength in certain types of people with HIV. Your physical therapist will work with you to set up an exercise program customized for you, adjusting it over time depending on how much you improve or any changes in your medical condition.

If you have nerve damage (neuropathy), your therapist may provide bracing and other techniques to make it easier for you to move. Your therapist also may recommend an “assistive device,” such as a walker or a cane, to improve your ability to walk safely.

Improve Your Heart Health

Many people with advanced HIV disease have a decreased ability to use oxygen (called your “aerobic capacity”). Research shows that aerobic exercise, such as walking on a treadmill for at least 20 minutes 3 times per week, may help improve your fitness and help maintain your body’s ability to fight HIV disease.

Improve Your Balance

With advanced disease, you might develop problems with balance or walking. This can be related to opportunistic infections that involve the brain or nerves. Physical therapists are experts in balance. Your therapist will improve your ability to walk using various techniques such as strengthening exercises, walking training, and balance activities. Your therapist also may fit you with a cane or other device and will train you in how to use it so that you can walk safely.

Reduce Your Pain

Living with HIV disease for many years can lead to neuropathy, causing muscle pain, burning sensations, numbness, tingling, cramps, spasm, and weakness. Your physical therapist will design exercises that involve stretching tight muscles and strengthening weak ones. Using manual therapy, your therapist will reduce the pain around your joints. Your therapist might decide to use a technique called electrical stimulation to help decrease your pain.

Maintain a Healthy Body Weight

By creating an exercise and physical activity program tailored for you, your therapist will help you maintain a healthy body weight, which can improve your energy level and help your immune system work better. Your therapist also can help you avoid becoming overweight. According to research, some of the new drugs tend to add pounds, living longer means age-related weight gain, and people with HIV and AIDS tend to take part in risky behavior, such as eating too much. Obesity and HIV disease together can cause changes in certain parts of the brain, interfering with your ability to move and keep your balance.

has decided to visit the therapist for a reevaluation in 6 months.

Real Life Experiences

Rita is a 60-year-old retired nurse. She was diagnosed with HIV disease 15 years ago and has been taking antiretroviral medications as prescribed by her infectious disease specialist for the past 12 years. She began to experience burning pain in both feet a few years ago due to peripheral neuropathy caused by her disease. Recently, she has had low back and left hip pain when walking. After conducting an examination that includes tests for range of motion and strength, the physical therapist determines that she has limited motion in the spine and hip and weakness in certain muscles around the left hip.

To help increase her ability to move and relieve her pain, her therapist designs a 2-week course of manual therapy that includes gentle movement of the spine and hip joints. He also designs exercises for muscle strengthening and gives her instruction in a home exercise program.

After this course of treatment, Rita reports complete relief of her low back pain and a 50% decrease in her hip pain. Because she still has some hip pain, the physical therapist refers her for an x-ray of the hip to help determine the cause of the pain. The x-ray shows mild arthritis. Based on Rita’s progress so far and based on the x-ray results, the therapist continues manual therapy, progresses the hip exercise program, and instructs Rita in how to use a cane when walking for long distances. These treatments result in further improvement of her hip pain. The therapist adds treatment for Rita’s foot pain, including electrical stimulation, soft arch supports, and foot exercises.

Within a few weeks, Rita feels that her hip pain is almost gone, although she continues to use a cane when walking long distances. She still has burning sensations in her feet due to neuropathy, but the severity of this pain is reduced, and she feels more in control of her chronic foot pain now. Rita is discharged from physical therapy, but her therapist will follow up with her via email in a month to see how she is doing. Rita has decided to visit the therapist for a reevaluation in 6 months.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries in people with HIV disease or AIDS. You may want to consider:

  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool that built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you’re looking for a physical therapist (or any other health care provider):

  • Get recommendations from family and friends or from other health care providers.
  • When you contact a physical therapist for an appointment, be sure to ask about his or her experience in helping people with underlying HIV disease or AIDS.
  • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Further Reading

The following articles provide some of the best scientific evidence related to physical therapy treatment of people with HIV disease or AIDS. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are listed by year and are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Bauer LO, Wu Z, Wolfson LI. An obese body mass increases the adverse effects of HIV/AIDS on balance and gait. Phys Ther. 2011 April 28

[Epub ahead of print]. Article Summary on PubMed.

Fillipas S, Cherry CL, Cicuttini F, et al. The effects of exercise training on metabolic and morphological outcomes for people living with HIV: a systematic review of randomised controlled trials. HIV Clin Trials. 2010;11:270-282. Article Summary on PubMed.

Sandoval R, Runft B, Roddey T. Pilot study: does lower extremity night splinting assist in the management of painful peripheral neuropathy in the HIV/AIDS population? J Int Assoc Physicians AIDS Care (Chic). 2010;9:368-381. Article Summary on PubMed.

Jong E, Oudhoff LA, Epskamp C, et al. Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era. AIDS. 2010;24:1387-1405. Article Summary on PubMed.

O’Brien K, Nixon S, Tynan AM, Glazier R. Aerobic exercise interventions for adults living with HIV/AIDS. Cochrane Database Syst Rev. 2010;(8):CD001796. Article Summary on PubMed.

O’Brien K, Tynan AM, Nixon S, Glazier RH. Effects of progressive resistive exercise in adults living with HIV/AIDS: systematic review and meta-analysis of randomized trials. AIDS Care. 2008 20:631-653. Article Summary on PubMed.

Gonzalez-Duarte A, Robinson-Papp J, Simpson DM. Diagnosis and management of HIV-associated neuropathy. Neurol Clin. 2008;26:821-832.  Article Summary on PubMed.

Dudgeon WD, Phillips KD, Carson JA, et al. Counteracting muscle wasting in HIV-infected individuals. HIV Medicine. 2006;7:299-310. Free Article.

Cade WT, Peralta L, Keyser RE. Aerobic exercise dysfunction in human immunodeficiency virus: a potential link to physical disability. Phys Ther. 2004;84:655–664. Free Article.

Manfredi R. HIV disease and advanced age: an increasing therapeutic challenge. Drugs Aging. 2002;19:647-669. Article Summary on PubMed.

Acknowledgments:  Mary Lou Galantino, PT, PhD, MSCE, and David M. Kietrys, PT, PhD, OCS