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    Move Forward Guide

    Physical Therapist's Guide to HIV Disease 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 develops when the HIV retrovirus invades the body. HIV is most commonly passed from person-to-person through:

    • Sexual relations
    • Exposure to contaminated blood
    • Hypodermic needle-sharing or accidental punctures
    • Mother-to-child transmission during pregnancy, childbirth, or breastfeeding

    AIDS is the advanced stage of HIV infection, and is marked by the onset of serious, life-threatening “opportunistic” infections that can occur because a person’s immune system is failing.

    These infections, as well as the current medical treatment for HIV called antiretroviral therapy (ART), can cause muscle, joint, nerve, or soft-tissue conditions that can interfere with normal movement and endurance.

    Signs and Symptoms

    HIV infection and AIDS can cause a number of medical symptoms that are described on the Centers for Disease Control and Prevention website. The symptoms listed there are not treated with physical therapy, but by a physician.

    HIV-related problems that can be treated by physical therapists are:   

    • Chronic pain
    • Burning sensations
    • Numbness
    • Tingling
    • Cramps
    • Spasms
    • Muscle weakness
    • Muscle or joint stiffness
    • Balance problems
    • Dizziness
    • Fatigue
    • Difficulty walking or using stairs
    • Difficulty performing work, sports, or recreational activities
    • Nerve damage that results in pain, burning sensations, numbness or tingling in the arms, legs, or feet (known as “peripheral neuropathy”)
    • Muscle aches and pains (myalgia)
     

    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 Is It Diagnosed?

    HIV infection can only be diagnosed by a physician.

    Physical therapists can evaluate people for symptoms occurring as a result of a diagnosed HIV infection, or due to the side effects of treatment with antiretroviral therapy. They design individualized programs of care and recovery for each person’s specific problems and goals.

     

    How Can a Physical Therapist Help?

    Although physical therapists do not treat HIV disease directly (that treatment is provided by an infectious disease specialist), they play an important role in treating movement and daily function problems. People with HIV disease also can experience sprains, strains, or age-related conditions, such as arthritis, that can be treated by a physical therapist. Your physical therapist's overall goal is to improve your quality of life and to help you remain active at home, at work, and in your community.

    Your physical therapist will conduct a thorough evaluation of your body to identify the causes of any pain or difficulty with movement and physical activity. Your physical therapist will select from a variety of treatments to address your specific needs. Treatments can help relieve pain and improve heart health, balance, and the ability to perform daily activities.

    Your physical therapist will work with you to improve:

    Pain levels. HIV infection and medication can cause pain, burning sensations, numbness, tingling, cramps, spasms, and weakness. Your physical therapist may apply hands-on techniques (manual therapy) or technologies like electrical stimulation to help decrease your pain. Your physical therapist may teach you gentle exercises or techniques to perform at home to reduce your pain. All of these options may reduce or eliminate the need for opioid pain medication.

    Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement to any joints and muscles that are stiff. These might begin with “passive” motions that the physical therapist performs for you to gently move your joints and muscles, and progress to “active” exercises and stretches that you perform yourself.

    Recovery. Your physical therapist will teach you exercises to perform at home, designed for your specific needs, to help speed your recovery from specific symptoms and problems.

    Performance of daily activities. Your physical therapist will discuss your daily activity challenges and goals with you and help you set your work, home life, and sports recovery goals. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you reach your goals in the safest, fastest, and most effective way possible.

    Heart health. People with advanced HIV disease may have a decreased ability to process oxygen (aerobic capacity), causing fatigue. Research shows that aerobic exercise, such as walking on a treadmill for at least 20 minutes, 3 times per week, may help improve aerobic capacity and maintain the body’s ability to fight HIV disease. Your physical therapist can assess your aerobic capacity and determine the best activities for you.

    Walking. Your physical therapist will help improve your ability to walk using techniques such as strengthening exercises, walking training, and balance activities. If you have nerve damage (neuropathy), your physical therapist may provide bracing and other techniques to make it easier or safer for you to walk. Your therapist also may recommend using an assistive device, such as a walker or a cane.

    Strength. Long-term HIV infection and ART can result in the loss of muscle strength and muscle bulk (myopathy). Research shows that exercise using weights is effective in increasing strength in people with HIV. Your physical therapist will work with you to set up an exercise program customized just for you, adjusting it over time to address any changes in your medical condition. Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to use.

    Flexibility. Your physical therapist will determine if any of your muscles are tight, begin to gently stretch them, and teach you how to stretch them. For extreme tightness, your physical therapist may apply certain treatments prior to stretching, such as hot packs, to help relax and loosen the muscles.

    Coordination. Your physical therapist will help you improve and regain your coordination and agility, so you can perform household, community, and sports activities with greater ease.

    Endurance. Your physical therapist will teach you exercises to improve endurance, so you can return to your normal activities. Cardio-exercise equipment may be used, such as treadmills or stationary bicycles.

    Balance. Your physical therapist will examine your balance, and choose specific exercises you can perform in the clinic and at home to improve your balance and prevent falls. Your physical therapist also may teach you how to use a cane or walker to help maintain your balance when walking and standing.

    Body weight. By creating an exercise and physical activity program tailored just for you, your physical therapist will help you maintain a healthy body weight, which can improve your energy levels and boost your immune system.

     

    Real Life Experiences

    Rita is a 60-year-old retired nurse. She was diagnosed with HIV disease 15 years ago and is taking antiretroviral medications, as prescribed by her infectious disease specialist. A few months ago, Rita began to experience burning pain in both feet. Recently, she has started to feel pain in her low back and left hip when walking. She decides to see her physical therapist.

    After conducting a thorough examination, including tests for motion and strength, Rita’s physical therapist determines that she has limited motion in the spine and hip, weakness in certain muscles around the left hip, and nerve damage that is causing her foot pain. He designs a program to address all of Rita’s symptoms and problems, and to help her reach her personal goals for daily activities and function.

    To help increase Rita’s ability to move, and to relieve her pain, her physical therapist starts a program of hands-on treatment (manual therapy) and corrective exercises that include gentle movement of the spine and hip joints. He teaches her specific exercises for muscle strengthening that she also can do at home.

    After her initial 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, her physical therapist refers her to her physician and requests an X-ray of the hip. The X-ray shows mild arthritis. Rita’s physical therapist continues her manual therapy and hip exercise program, and teaches her how to use a cane when walking long distances. These treatments result in further improvement and lessening of her hip pain. He provides treatment for her foot pain, including electrical stimulation and foot exercises, and prescribes the use of soft arch supports in her shoes.

    Within a few weeks, Rita feels that her hip pain is almost gone, although she continues to use a cane when walking long distances. The burning sensations in her feet are reduced, and she feels more in control of her chronic foot pain.

    Rita is discharged from physical therapy, but her physical therapist follows up with her via email in a month to see how she is doing. She reports that she can perform all of her daily activities, and schedules a physical therapy reevaluation in 6 months.

    This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat a variety of physical 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 in neurologic physical therapy, and has advanced knowledge, experience, and skills that may apply to your condition, as shown by continuing education courses attended or certification as a neurologic clinical specialist in physical therapy.

    You can find physical therapists who have these and other credentials by using Find a PT, the online tool 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 their 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 to describe what makes them worse.
     

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

    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.

    O'Brien K, Tynan AM, Nixon SA, Glazier RH. Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infect Dis. 2016;16(1):182. Free Article.

    Mocumbi AO. Cardiac disease and HIV in Africa: a case for physical exercise. Open AIDS J. 2015;9:62-65. Free Article.

    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.

    *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.

    Authored by Mary Lou Galantino, PT, PhD, MSCE, and David M. Kietrys, PT, PhD,. Reviewed by the MoveForwardPT.com editorial board.

    Authored by Mary Lou Galantino, PT, PhD, MSCE, and David M. Kietrys, PT, PhD, OCS. Reviewed by the MoveForwardPT.com editorial board.

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