Topic

Continuum of Care in HIV:Navigating HIV as a Chronic and Episodic Disease

Learning objectives

• Outline the current status of the HIV pandemic and the role of the physiotherapist in the continuum of care across the lifespan
• Examine the evidence available on managing HIV disease as an episodic and chronic illness and its impact on the disability experienced by people living with HIV.
• Define the impact of HIV on the patient, caregiver/community, healthcare worker and the healthcare system across the lifespan.
• Compare models of HIV physiotherapy care in different regions of the world

Description

It has been 30 years since the first HIV case was diagnosed. With the introduction and improved availability of highly active antiretroviral therapy (HAART) HIV has moved from being a terminal disease to a chronic and episodic illness. Co-morbidities  resulting from HAART  or aging with HIV may contribute to the increased disability experienced by people living with HIV/AIDS as well as a chronic and  episodic pattern of morbidity. HIV thus causes disability but also affects people with disabilities. People with pre-existing disabilities and now living with HIV have faced a double burden of stigma. Physiotherapists have been involved in the chronic management of HIV and in the last decade have actively researched, using rehabilitation frameworks such as the ICF, to better understand management of HIV. The impact of HIV on the patient, caregiver/community, healthcare worker and the healthcare system has to be understood and managed in order for effective rehabilitation intervention and optimal quality of life to be realised.

Implications

Emerging evidence supports the increased involvement of  physiotherapists in managing the co-morbidities and disability resulting from HIV infection and side effects of medication (Myezwa et al 2009). For example, physiotherapy interventions for neuropathic pain are necessary to restore function (Galantino, 2013,1998,1999). Exercise has the ability to enhance outcomes of cardiorespiratory fitness, strength, weight and body composition, and quality of live for people infected with HIV ( O’ Brien et al 2012, 2008). Other traditional and integrative approaches have been implemented with people living with HIV experiencing episodic disability (Galantino, 2005).

After three decades there is still no cure for HIV, research shows that any waning of efforts in prevention treatment and care results in an upsurge of the various points across the life span of the epidemic.  Vigilance on the part of therapists (rehabilitation team) requires a review of the roles and the evidence available across the lifespan and within the continuum of care.