HIV and AIDS

Question 1

What is the distinction between HIV and AIDS?

Answer 1

HIV: retrovirus that targets WBC called leukocytes or T4 cells (CD4 receptor)
normal CD4 550-15000
Any CD4 count below 300cells puts pt at risk for AIDS
without T4 cells to protect immune system, bacteria, fungi, viruses and parasites infect the body .
(starting tx earlier, more cases of HIV than AIDS, higher life expectancy).

AIDS- acquired immunodeficiency syndrome.
chronic life threatening issue caused by HIV virus.

Question 2

AIDS

Answer 2

karposis sarcoma- cancer on the skin- purple blothes
thrush- fungal infection in the mouth
Pneumocytis carinii pneumonia- specific pneumonia seen with pts with HIV, weakness, SOB

Question 3

What population of people in the US is at risk for new infections?

Answer 3

youth aged 13-24 years account for >25% of new infections

Question 4

What are the stages of HIV?

Answer 4

Acute infection- within 2-4 wks, large amounts of virus are produced, feels like “worst flu ever”
Clinical Latency- HIV reproduces at slow stages, although still active, may be symptomatic and may last 20-40 years now (cells multiply)
AIDS- CD4 cells fall below 200 (official dx) Opportunistic infections develop and without TX survival is typically no more than 3 yrs.

Question 5

What are the clinical problems related to HIV and AIDS (musculoskeletal, neuro, etc)?

Answer 5

Musculoskeletal=
myopathy- weakness of muscles- inactivity, incoordination, decreased ROM and strength
Polymyositis- inflammatory process of the muscles (WDC chnages)
Fatigue
Weakness
Neuro= cognitive- executive fx skills such as, attention, motivation, emotions, AIDS dementia (later stages)
Peripheral Neuropathy- 1/3 develop in their feet with numbness, tingling, burning, pain and ms weakness
cytomegalovirus retinitis- causes blindness

Question 6

What are the clinical problems related to HIV and AIDS (co-morbidities andmedical comp.)

Answer 6

co-morbidities- cardiovascular, cancer, renal dysfunction, liver dysfunction, osteoporosis
medical comp- deconditioning. edema (limbs or major organs), skin breakdown, dysphagia, risk for joint contractures.
Chronic illess- tends to be episodic (mixed with moments of wellness and illness)

Question 7

What OT assessments are relevant for HIV and AIDS infected clients?

Answer 7

COPM, ACL, Exec. perf., visual screens, strength, ROM, sensation, SF-36 (depression/quality of life), CPT, KATZ, fatigue, comm. resources, finances, IADL’s, KELS, BI
look across board, depending on how they present
always looks for neuro deficits

Question 8

What areas of occupational performance are likely impacted?

Answer 8

ADL's
environmental barriers (adaptive devices)
energy conservation, work simplification, safety, compensations for motor and visual strength loss, prioritize
**IADL's - shopping, meal prep, banking, traveling, idep. living skills -depends on support and resources 
ROM-pulleys
strength- keep simple
muscles tone
coordination
endurance-overall habits and routines/modify habits 
voluntary UE use
sensation-compensate thru vision
pain-ice, heat, positioning
cognition
vision and perception
patient caregiver education
vocational and leisure
psychosocial support