1. Human Immunodeficiency Virus
C H A P T E R 21
Human Immunodeficiency Virus
Archer, Albrecht, Hand
Chapter 21

2. Definition The definition has evolved since 1983
2008 definition (most recent) from the Centers for Disease Control (CDC):
HIV antibody test
Fewer than 200 CD4+ cells/µl
24 clinical conditions

3. Table 21.1

4. Disease Scope Up to 60 million infected worldwide
Up to 25 million have died
2002 health care expenditures: $36.4 billion
~50,000 new cases per year in United States
~20% do not know they are infected
Initially affected mostly white gays
Now affecting lower socioeconomic classes primarily

5. Pathophysiology
Infection from transfer of body fluid (e.g., blood, semen, vaginal secretions, breast milk)
Sexual contact, perinatal exposure, IV drug use
Not transferred by insects, saliva, or sweat
Time course
Seroconversion (to greatly increased HIV viral load in blood) illness immediately after transfer for few days to several weeks
Symptoms: sore throat, fever, fatigue, lymphadenopathy, rash, myalgia, malaise, oral/esophageal sores
Followed by CD4 cell decrease
Wasting (unintentional >5% weight loss), typically occurring later in disease process
(continued)

6. Pathophysiology (continued)
Metabolic complications—increase in cardiac disease risk
Lipodystrophy—loss of subcutaneous fat deposits
Cardiac dysfunction—HIV is related to a number of cardiac complications including diastolic dysfunction, arrhythmias, atherosclerosis, vasculitis, pericardial effusion, and others

7. Clinical Considerations
Stage 1: primary infection; asymptomatic and lasts for a few weeks
Stage 2: clinically aymptomatic and can last for years
Stages 3/4: critically ill and diagnosis presumed based on signs and symptoms
Signs and symptoms: vary with degree of illness and treatment
Viral illness symptoms (fever, pharyngitis, malaise, rash) within 1 mo of exposure
Lipodystrophy
Impaired glucose and lipid metabolism
CVD risk factors
Wasting
(continued)

8. Clinical Considerations (continued)
History and physical exam
Should focus on:
General physical examination
Changes in body weight (wasting)
Indications of metabolic disorders (lipodystrophy)
Motor abnormalities (hyperreflexia, loss of equilibrioception)
CV disease (arrhythmias, edema)
Peripheral neuropathy (common issue with those on HAART therapy)
Behavioral/psychological symptoms: fatigue, malaise, depression anxiety, isolation, lower QOL
(continued)

9. Clinical Considerations (continued)
Diagnostic testing
HIV blood test: assess for presence of HIV antibodies or viral load
Rapid antibody tests are used only for point-of-care testing and are not definitive
Exercise testing:
Considered safe
Can be used to evaluate CVD risk, especially in those at high risk
Assess for HAART-related orthopedic complications (osteonecrosis, bone tumors, and so on)
Avoid testing if acutely ill
Consider assessing body composition, flexibility, strength, and physical functioning/cardiorespiratory fitness
(continued)

10. Clinical Considerations (continued)
See table 21.2 for exercise testing and physical fitness and function review.

11. Treatment 29 drugs are FDA approved to treat HIV.
These are in five classes:
Protease inhibitors (PIs)
Nucleoside reverse transcriptase inhibitors (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (non-NRTIs)
Fusion inhibitors (FIs)
Integrase inhibitors
(continued)

12. Treatment (continued)
These medications can result in adverse side effects:
Diabetes
Hyperglycemia
Lipodystrophy
Hyperlipidemia
Also consider:
Nutrition
Exercise and physical activity
Lifestyle change to control modifiable risk factors

13. Exercise Prescription
Should receive medical clearance
Goals: enhance physical functioning and QOL and reduce morbidity
Modify for the individual circumstances
Strongly consider methods to positively affect adherence
For CV training:
Reduce initial intensity and volume before beginning exercise training to reduce risk of nonadherence due to effort.
(continued)

14. Exercise Prescription (continued)
Resistance training:
Adhere to general ACSM guidelines
Take into account HIV stage
Consider no training or very reduced intensity if:
Osteonecrosis
Peripheral neuropathies
Range of motion training:
Follow general flexibility training guidelines from ACSM
Slower-progression mild stretching recommended

15. Exercise Training
See table 21.4 for exercise prescription review.

16. Conclusion Exercise training is safe and beneficial
Advances in treatment (HAART) have allowed patients to live longer and develop HIV-related comorbidities that exercise may help to prevent
Need to overcome unwillingness to regularly exercise