HIV/AIDS

HIV
H Human This particular virus can only infect human beings.
I Immunodeficiency HIV weakens your immune system by
destroying important cells that fight disease and infection. A
"deficient" immune system can't protect you.
V Virus A virus can only reproduce itself by taking over a cell
in the body of its host.

AIDS
A Acquired AIDS is not something you inherit from your parents. You
acquire AIDS after birth.
I Immuno Your body's immune system includes all the organs and
cells that work to fight off infection or disease.
D Deficiency You get AIDS when your immune system is "deficient,"
or isn't working the way it should.
S Syndrome A syndrome is a collection of symptoms and signs of
disease. AIDS is a syndrome, rather than a single disease, because it
is a complex illness with a wide range of complications and
symptoms

Structure of the HIV-1 virus. A

glycoprotein
envelope
surrounds the virus, which
carries its genetic material
in RNA. Knobs, consisting of
protein GP120 and GP41,
protrude from the envelope.
These proteins are essential
for binding the virus to the
CD4+ T lymphocyte. From
Porth,
C.
(2002).
Pathophysiology: Concepts
of altered health states (6th
ed.). Philadelphia: Lippincott
Williams & Wilkins.

 T cells - cell involved in regulating the immune systems

response to infected or malignant cells
Antibodies - substance produced by the body that destroys
bacteria and viruses
CD4 cells - type of lymphocyte ( white blood cell). They are an
important part of the immune system and are sometimes called
the T cells.
T4 cells ( CD4+)- are helper cells . Key role in the immune
systems ability to recognize and defend against pathogens.
They lead the attack against infections
T8 cells (CD8+)- are suppressor cells that end the immune
response. They can also be killer cells that kill cancer cells and
cells infected with a virus.

ETIOLOGY
HIV belongs to a group of viruses known as retroviruses. These
viruses carry their genetic material in the form of ribonucleic
acid (RNA) rather than deoxyribonucleic acid (DNA). It is most
commonly transmitted through sexual contact. It can also be
transmitted through the use of contaminated needles or blood
transfusions and prenatally from mother to fetus (NIH, 2005).

AIDS is the consequence of a chronic retroviral infection that

produces severe, life-threatening CD4 helper T lymphocyte
dysfunction and destruction
Two genetically different but antigenetically related form of HIV:
HIV-1 : Isolated from patients with AIDS and the most common type
HIV-2 : associated with AIDS

Epidemiologic studies in the

United States have identified 5 groups of adults at risk
for developing AIDS.
Homosexual or bisexual men
Intravenous drug abusers
Hemophiliacs
Recipients of blood and blood components
Heterosexual contacts of members of
other high risk groups constitute 10% of
the patient population
In approximately 6% of cases, risk factors
cannot be determined
NOTE:
Comparing race/ ethnicity among the three
largest groups diagnosed in 2001, 20,752
were black, not Hispanic; 11,675 were
Caucasian; and 8,221 were Hispanic (CDC,
2002)

Transmission is by:
Sexual intercourse
Mother to child
Contaminated
blood, blood
products and organ
donations
Contaminated
needles

Transmission...

In the process of taking over the CD4+ T

cell, the virus attaches to receptors on
the CD4+ cell, fuses to and enters the
cell, incorporates its RNA into the cells
DNA, and then uses the CD4+ cells
DNA to reproduce large amounts of
HIV, which are released into the blood.

Three phases of HIV

Primary HIV acute
infection
occurs in most
individuals 24
weeks after infection
symptoms include
fever,
maculopapular rash,
myalgia,
headache/aseptic
meningitis

Clinical
Latency
most cases are
asymptomatic
subgroup of
patients
develop
lymphadenopa
thy (>1 cm)
possible
splenomegaly

- Overt AIDS

rise in viral load

a fall in CD4 count
development of symptoms and
signs due to direct HIV effects and
immunosuppression

Primary Infection (Acute/Recent HIV

Infection, Acute HIV Syndrome)
The period from infection with HIV to the development of
HIV-specific antibodies is known as primary infection.
Initially, there is a window period during which an HIVpositive person tests negative on the HIV antibody blood
test, although he or she is infected and highly infectious,
because his or her viral load is very high. After 2 to 3
weeks, anti- bodies to the glycoproteins of the HIV
envelope can be detected in the sera of HIV-infected
people, but most of these antibodies lack the ability to
totally control the virus. By the time neutralizing
antibodies can be detected, HIV-1 is firmly established in
the host.

CLINICAL CATEGORIES
HIV Asymptomatic (CDC Category A:
More Than 500 CD4+ T
Lymphocytes/mm3)
HIV Symptomatic (CDC Category B:
200 to 499 CD4 + T
Lymphocytes/mm3)
AIDS (CDC Category C: Fewer Than
200 CD4+ T Lymphocytes/mm3)

Differential Diagnosis
In patients presenting with constitutional symptoms such as
weight loss and fevers, differential considerations include:
-cancer chronic infections such as tuberculosis and endocarditis,
and endocrinologic
diseases such as hyperthyroidism
When pulmonary processes dominate the presentation consider
- acute and chronic lung infections
When neurologic disease is the mode of presentation, conditions
that cause mental status changes or neuropathy
- eg, alcoholism, liver disease, kidney dysfunction, thyroid
disease, and vitamin deficiencyshould be considered.
If a patient presents with headache and a cerebrospinal fluid
pleocytosis, other causes of chronic meningitis enter the
differential.
When diarrhea is a prominent complaint,
infectious enterocolitis, antibiotic-associated colitis,
inflammatory bowel disease, and malabsorptive symptoms
must be considered.

DIAGNOSTIC PROCEDURES

DIAGNOSTIC PROCEDURES
HIV- antibody test
ELISA (Enzyme -linked
Immunosorbent assay
Western blot assay
OraSure test
Home-based testing for HIV
antibodies
Viral load tests

CLINICAL MANIFESTATIONS
According to NIH (2005), individuals begin to present with flulike
symptoms within one to two months after exposure to HIV/
AIDS. During this period, people are very infectious, and HIV
is present in large quantities in genital fluids. More persistent
or severe symptoms might not appear for 10 years or more
after HIV first enters the body in adults or within two years
who are born HIV positive (NIH, 2005). As the immune
system deteriorates, the first signs of infection occur in the
large lymph nodes. According to the NIH, the most prevalent
symptoms prior to the onset of AIDS include the ff:
Lack of energy
Weight loss
Frequent fever and sweats
Persistent or frequent yeast infections (oral or vaginal)
Persistent skin rashes or flaky skin
Pelvic inflammatory disease in women that does not
respond to treatment
Short-term memory loss

According to NIH (2005), symptoms

related to the onset of opportunistic
illness incude the ff:

Coughing and shortness of breath

Seizures and lack of coordination
Difficult or painful swallowing
Mental symptoms such as confusion and
forgetfulness
Severe and persistent diarrhea, nausea,
abdominal cramps, and vomiting
Vision loss
Weight loss and extreme fatigue
Severe headaches
Coma

COMPLICATIONS
Systemic
- weight loss and wasting
syndrom
- nausea
Respiratory Manifestations
- Pneumocystis carinii Pneumonia
- Mycobacterium tuberculosis- Mycobacterium Avium Complex
Gastrointestinal Manifestations &
Swallowing Disorders
- Candidiasis
-Kaposi's Sarcoma
-Esophagitis
- Intestinal Parasites

Nervous System Manifestation

-HIV-associated Dementia
- Progressive Multifocal
Leukoencephalopathy
- CNS LYMPHOMA
- Cryptococcal Meningitis
CANCERS and MALIGNANCIES
- Kaposis Sarcoma
- Wasting Syndrome

PROGNOSIS
At present there is no cure for AIDS and it is fatal
without treatment. HIV infection, however, takes a
very long time to develop into full blown AIDS. The
virus begins to replicate in the body within the
CD4 cells and begins to destroy the immunity (Dr
Ananya Mandal, MD)
The time taken for development of AIDS from HIV
infection may range from 6 months (very rare) to
15 years. In the UK the average time to
development of AIDS from initial HIV infection is
around 12 years.

PT MANAGEMENT

APPROPRIATE INTERVENTIONS
w/ exercise , there is a trend that reveals an increase in CD4 levels
Exercise introduced early in infection can help stave off
opportunistic infections
PRE helps improve the functional status of patients

Therapeutic Exercise
Passive movement
Assisted active movement
Active movement
Assisted-resisted active movement
Resisted movement
Electrical modalities - pain management
Neuromuscular electrical stimulation (galvanic and faradic)
Functional electrical stimulation,
Iontophoresis
High-voltage pulsed galvanic current
Transcutaneous electrical nerve stimulator (TENS)

Thermal modalities- effective adjuncts to exercise and/or

electrical modalities
Cryotherapy (ice massage, cold pack, cold bath,
vapocoolant spray)
Supericial heating agents (fluidotherapy, hot pack, infrared
radiation, paraffin wax, contrast baths)
Deep heating agents ( diathermy - shortwave, microwave)
Hydrotherapy ( whirlpool, contrast baths)
Mechanical Therapy
Traction therapy
Compression therapy - useful in lymphedema

RATIONALE OF TREATMENT
Providing palliative care improve outcomes in patients in
living with HIV or AIDS. Dysfunction of the aerobic
system as a major cause of physical disability in HIV
patients was found by Cade et al, and hence other
authors Nixon et al., found aerobic exercise interventions
to be effective. O Brien Et al, advocated positive effects
for progressive resisted exercise. Therapeutic massage
was found to be effecttive by Hillier. Crepaz found
cognitive-behavioral interventions to have positive effect
on mental functioning and also immune functioning in
patients living with HIV.

CONTRAINDICATIONS /
PRECAUTIONS
Traction, Manual Therapy, - active inflammatory
or infective arthritis, Joint and ligament
instability, malignancy. Ultrasound- patients
with reduced sensation to pain & heat, Local
malignancy, over areas of thrombosis or other
vascular abnormalities. Electrical- pregnant
women, pain of unknown origin, pxs with
pacemakers. Cryotherapy - decreased cold
sensitivity / hypersensitivity, cold allergy,
circulatory or sensory impairment, arthrittis,
hypertension, cardiac or respiratory disorders.

NEW TRENDS AND

INNOVATIONS
New studies show significant breakthrough in
HIV prevention, says UN agency combating virus
HIV is evolving to become less deadly and less
infectious, according to a major scientific study.
Monkey HIV Vaccine Success Opens Door for
Human Trials

MEDICAL
Antiretroviral drugs
Combination therapy w/ three or more active antiretroviral
agents in order to achieve an undetectable HIV viral load in
plasma has become the standard care.
RT Inhibitors- inhibits process of reverse transcription,
preventing viral RNA from being transcribed into cellular DNA
Protease inhibitors - production of immature, noninfectious
HIV-1 particles by blocking the cleavage of HIV-1 polyproteins
into component proteins
Novel agents- one fusion inhibitor approved for use by the
FDA : enfuvirtide
- polypeptide binds to GP41 transmembrane
protein on the HIV virion and prevents the conformation
change required to fuse the virion with the CD4 cell
membrane thus inhibiting viral entry.
- injected subcutaneously

 HAART
Treatment regimens for HIV infection are complicated and
require long term commitment
assessment and laboratory marker data including viral load
and CD4 counts
Patients may need to change therapy because of drug
resistance or intolerance/adverse drug reactions.

Pharmacological
RT Inhibitors
Protease inhibitors
Novel agents

SURGICAL
Splenectomy for Immune Deficiency-Associated
Thrombocytopenic Purpura
Open lymph node biopsy - Lymphadenopathy
Thoracic Surgery
Cholecystectomy - Acute Cholecystitis
CT-guided stereotactic needle biopsy- Intracranial Lesions
Anorectal Surgery

Others:
OT: Basic and Instrumental Activity of Daily Living Skills
Psychososcial Skills
Cognitive/ Perceptual Skills
Self- Perception
Somatic Sensory Evaluations
NURSING: Obtain and assess Nuttritional status
Inspect Skin & Mucous membranes for any ulceration or
laceration ; Promoting Skin Integrity
Monitor respiratory status
Assess Mental status, Fluid and electrolyte status
Level of knowledge evaluation
Maintaining Usual Bowel Pattern

MT: reparing cultures of tissue samples

Establishing and monitoring programs that ensure data
accuracy
Cross-matching blood for transfusions
Chemically analyzing blood or urine for toxic components
Analyzing lab reports for accuracy
Delivering test results to physicians, researchers or
patients
Collecting and studying blood samples to determine
morphology
IV. PREVENTIVE MEASURE AGAINST POSSIBLE COMPLICATIONS
Antidiarrheal Therapy
Chemotherapy
Antidepressant Therapy
Nutrition Therapy

V. REFERENCES
Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarths Textbook of
Medical Surgical Nursing (12th Ed) Philadelphia: Lippincott Williams & Wilkins
Cotran R.,Kumar V., Collins T. (1999). Pathologic basis of disease 7th ed. WB SaundersCompany,
Porth, Carol, Glenn Matfin and Carol Mattson Porth. Pathophysiology: Concepts of Altered Health
States. Th ed. Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins, 2009. Print
Delisa, J.A(2011) . Physical Medicine and Rehabilitation5th ed. Philadelphia: Lippincott Williams and
Wilkins
Schecter W.P. Stock S. P. (2003, Febraury). Surgery in Patient with HIV. Hininsite.ucsf.edu
Remnie, S. (2011, January, 5).ELECTROPHYSICAL AGENTS - Contraindications And Precautions:
An Evidence-Based Approach To Clinical Decision Making In Physical Therapy. Ncbi.nlm.nih.gov
Gallagher J. (2014, December 1).HIV evolving into milder form. www.bbc.com
(2014, Septeember 2).Monkey HIV Vaccine Success Opens Door for Human
Trials.www.aidsmeds.com
Kim (2011 february 5).INDICATIONS & CONTRAINDICATIONS OF PHYSIOTHERAPY
TREATMENTS.www.physionique.com
(2015, February 25). New studies show significant breakthrough in HIV prevention, says UN agency
combating virus.www.un.org