HIV/AIDS For Physiotherapy 3 - PowerPoint Presentation

1. HIV/AIDSFor Physiotherapy 3rd year student Department of physiotherapyNeuro rehabilitation Ashenafi Zemed (MSc in PT)4/30/20201Stay home stay safe

2. IntroductionBy damaging your immune system, HIV interferes with the body's ability to fight the organisms that cause disease. HIV is a sexually transmitted disease. It can also be spread by contact with infected blood, or from mother to child during pregnancy, childbirth or breast-feeding.The HIV takes several years to convert into AIDS by weakens the immune system.There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many nations. 4/30/20202Stay home stay safe

3. Definition AIDS is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). 4/30/20203Stay home stay safe

4. History and originAIDS was first recognized in the United States in the summer of 1981, when the U.S. Centers for Disease Control and Prevention (CDC) reported the unexplained occurrence of Pneumocystis jiroveci (formerly P. carinii) pneumonia in five previously healthy homosexual men in Los Angeles and of Kaposi’s sarcoma (KS) with or without P. jiroveci pneumonia and other opportunistic infections in 26 previously healthy homosexual men in New York, San Francisco, and Los Angeles4/30/20204Stay home stay safe

5. The earliest known positive identification of the HIV-1 virus comes from the Congo in 1959 and 1960 though genetic studies indicate that it passed into the human population from chimpanzees around fifty years earlier. A 2007 study states that a strain of HIV-1 probably moved from Africa to Haiti and then entered the United States around 1969.HIV descends from the related simian immunodeficiency virus(SIV), which infects apes and monkeys in Africa. There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV. However, only a few of these infections were able to cause epidemics in humans, and all did so in the late 19th—early 20th century.History and origin cont’d4/30/20205Stay home stay safe

6. How HIV is transmittedTo become infected with HIV, infected blood, semen or vaginal secretions may enter in the body. The person can't become infected through ordinary contact — hugging, kissing, dancing or shaking hands with someone who has HIV or AIDS. HIV can't be transmitted through the air, water or via insect bites. Transmission of HIV in several ways, including: During sex: Person becomes infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter the body. The virus can enter your body through mouth sores or small tears that; sometimes develop in the rectum or vagina during sexual activity.4/30/20206Stay home stay safe

7. Cont.….Blood transfusions: In some cases, the virus may be transmitted through blood transfusions. Sharing needles:HIV can be transmitted through needles and syringes contaminated with infected blood. Sharing intravenous drug paraphernalia puts it at high risk of HIV and other infectious diseases such as hepatitis.From mother to child:Infected mothers can infect their babies during pregnancy or delivery, or through breast-feeding.But if women receive treatment for HIV infection during pregnancy, the risk to their babies is significantly reduced.4/30/20207Stay home stay safe

8. Introduction Clinical disease of the nervous system accounts for a significant degree of morbidity in a high percentage of patients with HIV infection . The neurologic problems that occur in HIV-infected individuals may be either primary to the pathogenic processes of HIV infection or secondary to opportunistic infections.Among the more frequent opportunistic diseases that involve the CNS are Toxoplasmosis, Cryptococcosis, Primary CNS lymphoma, Mycobacterial infections and Syphilis.Overall, secondary diseases of the CNS have been reported to occur in approximately one-third of patients with AIDS. 4/30/20208Stay home stay safe

9. Neurologic diseases of HIV infection4/30/2020Stay home stay safe9

10. Neurologic OIsDespite the availability of ART in the United States and other industrialized countries, OIs continue to cause considerable morbidity and mortality for three main reasons: (1) many patients are unaware of their HIV infection and present with an OI as the initial indicator of their disease; (2) some patients are aware of their HIV infection, but do not take ART due to psychosocial or economic factors; and (3) some patients are prescribed ART, but fail to attain adequate virologic and immunologic response due to issues related to adherence, pharmacokinetics, or unexplained biologic factors4/30/202010Stay home stay safe

11. Neurologic OIsIt is important to recognize that the relationship between OIs and HIV infection is bidirectional. HIV causes the immuno-suppression that allows opportunistic pathogens to cause disease in HIV-infected persons. OIs, as well as other co-infections that may be common in HIV-infected persons, such as sexually transmitted infections, can also have adverse effects on the natural history of HIV infection. Some OIs are associated with reversible increases in circulating viral loadThus, although chemoprophylaxis and vaccination directly prevent pathogen-specific morbidity and mortality, they may also contribute to reduced rate of progression of HIV disease.Reduced progression of HIV infection would also indirectly delay or reduce the occurrence of subsequent OIs.4/30/202011Stay home stay safe

12. Toxoplasmosis Toxoplasmic encephalitis (TE) is caused by the protozoan Toxoplasma gondii.Primary infection occasionally is associated with acute cerebral or disseminated disease.Epidemiology Varies substantially among different communities e.g., Approximately 15% in the united states and 50%–75% in certain European countries.4/30/2020Stay home stay safe12

13. ToxoplasmosisIf well-documented cases did occur, they would presumably represent either primary infection, reactivation of latent disease in patients unable to produce detectable antibodyThe incidence and associated mortality in Europe and the United States have decreased substantially with the initiation of ART and the broad use of prophylaxis regimens active against T. gondiiClinical disease is rare among patients with CD4+ counts >200 cells/μL. The greatest risk is among patients with a CD4+ count <50 cells/μL. Primary infection occurs after eating undercooked meat containing tissue cysts or ingestion of oocysts that have been shed in cat feces and have sporulated in the environment (sporulation requires at least 24 hours). No transmission of the organism occurs by person-to-person contact.4/30/2020Stay home stay safe13

14. ToxoplasmosisClinical featuresThe most common clinical presentation of T. gondii infection among patients with AIDS is focal encephalitis with headache, confusion, or focal lesions like aphasia, motor weakness or seizure and fever. Physical examination might demonstrate focal neurological abnormalities, and in the absence of treatment, disease progression results in seizures, stupor, and coma.4/30/2020Stay home stay safe14

15. ToxoplasmosisTreatment The initial therapy of choice for TE consists of the combination of pyrimethamine plus sulfadiazine plus leucovorin .Pyrimethamine penetrates the brain parenchyma efficiently even in the absence of inflammation. Use of leucovorin reduces the likelihood of the hematologic toxicities associated with pyrimethamine therapy.The preferred alternative regimen for patients with TE who are unable to tolerate or who fail to respond to first-line therapy is pyrimethamine plus clindamycin plus leucovorin4/30/2020Stay home stay safe15

16. ToxoplasmosisPrevention of recurrenceThe combination of pyrimethamine plus sulfadiazine plus leucovorin is highly effective as suppressive therapy for patients with TE and provides protection against PCP.A commonly used regimen as suppressive therapy for patients with TE who cannot tolerate sulfa drugs is pyrimethamine plus clindamycinAdult and adolescent patients receiving secondary prophylaxis for TE are at low risk of recurrence of TE when they have successfully completed initial therapy for TE, remain asymptomatic with regard to signs and symptoms of TE, and have a sustained increase in their CD4+ counts of >200 cells/μL after ART (e.g., >6 months)4/30/2020Stay home stay safe16

17. Symptoms The symptoms of HIV and AIDS vary, depending on the phase of infection. Primary infection The majority people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible symptoms include: Fever, Muscle soreness, Rash, HeadacheSore throat, Mouth or genital ulcersSwollen lymph glands, mainly on the neck, Joint pain, Night sweatsDiarrheaAlthough the symptoms of primary HIV infection may be mild enough to go unnoticed, the amount of virus in the blood stream (viral load) is particularly high at this time. As a result, HIV infection spreads more efficiently during primary infection than during the next stage of infection. 4/30/202017Stay home stay safe

18. Symptoms cont’dClinical latent infection In some people, persistent swelling of lymph nodes occurs during clinical latent HIV. Otherwise, there are no specific signs and symptoms. HIV remains in the body, however, as free virus and in infected white blood cells. Clinical latent infection typically lasts 8 to 10 years. A few people stay in this stage even longer, but others progress to more-severe disease easily caused. 4/30/202018Stay home stay safe

19. Progression to AIDS There is no treatment for the HIV infection, the disease typically progresses to AIDS in about 10 years. By the time AIDS develops, the immune system has been severely damaged, making the susceptible to opportunistic infections — diseases that wouldn't trouble a person with a healthy immune system. The signs and symptoms of some of these infections may include: Soaking night sweatsShaking chills or fever higher than 100 F (38 C) for several weeksCough and shortness of breath, Chronic diarrheaPersistent white spots or unusual lesions on the tongue or in the mouthHeadaches, Persistent, unexplained fatigueBlurred and distorted vision, Weight loss, Skin rashes or bumps4/30/202019Stay home stay safe

20. How does HIV become AIDS ?HIV destroys CD4 cells — a specific type of white blood cell that plays a large role in helping the body to fight from disease. The immune system weakens as more CD4 cells are killed. HIV infection for years before it progresses to AIDS. To be diagnosed with AIDS, If the CD4 count under 200 or experience an AIDS-defining complication, such as:Pneumocystis pneumoniaCytomegalovirus, Tuberculosis, Toxoplasmosis, Cryptosporidiosis4/30/202020Stay home stay safe

21. Harrison text book of internal medicine 19 edition4/30/202021Stay home stay safe

22. Risk factors When HIV/AIDS first surfaced in the United States, it predominantly affected homosexual men. The type of HIV found in many African nations is more easily spread through heterosexual sex. Anyone of any age, race, sex or sexual orientation can be infected, but person at greatest risk of HIV/AIDS if he: Have unprotected sex. Unprotected sex means having sex without using a new condom every time. Anal sex is more risky than is vaginal sex. The risk increases if he have multiple sexual partners.Have another STD. Many sexually transmitted diseases (STDs) produce open sores on the genitals. These sores act as doorways for HIV to enter in the body.Use intravenous drugs. People who use intravenous drugs often share needles and syringes. This exposes them to droplets of other people's blood.4/30/202022Stay home stay safe

23. Complications HIV infection weakens the immune system, making highly susceptible to all sorts of infections and certain types of cancers. Infections common to HIV/AIDS: Tuberculosis (TB): Salmonellosis:Cytomegalovirus (CMV) :Candidiasis Cryptococcal meningitis:Toxoplasmosis: Cryptosporidiosis:4/30/202023Stay home stay safe

24. Other complications Wasting syndrome:Neurological complications:Although AIDS doesn't appear to infect the nerve cells, it can still cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and trouble walking.One of the most common neurological complications is AIDS dementia complex, which leads to behavioral changes and diminished mental functioning.4/30/202024Stay home stay safe

25. Tests and diagnosis HIV is most commonly diagnosed by testing the blood or saliva for the presence of antibodies to the virus. Unfortunately, these types of HIV tests aren't accurate immediately after infection because it takes time for the body to develop these antibodies — usually up to 12 weeks. In rare cases, it can take up to six months for an HIV antibody test to become positive. A newer type of test checks for HIV antigen, a protein produced by the virus immediately after infection. This test can confirm a diagnosis within days of infection. 4/30/202025Stay home stay safe

26. Tests to treatmentFor diagnosis of HIV/AIDS, several types of tests can help to determine what stage of the disease he has. Most important tests are : CD4 count: CD4 cells are a type of white blood cell that's specifically targeted and destroyed by HIV. A healthy person's CD4 count can vary from 500 to more than 1,000. Even if a person has no symptoms, HIV infection progresses to AIDS when his or her CD4 count becomes less than 200.Viral load: This test measures the amount of virus in the blood. 4/30/202026Stay home stay safe

27. THE ROLE OF PHYSIOTHERAPY IN PEOPLE LIVING WITH HIV/AIDSPhysiotherapy plays an important role in caring and treatment of people suffering from conditions related to HIV/AIDS worldwide. It helps in optimization of life in these patients.This is a condition in which the human defense mechanism starts to fail and the body progressively deteriorates.Up-to-date the role of Physiotherapy in HIV patients is over looked and that’s why there are not included in most multi disciplined teams caring for HIV patients at hospital or even at community level. This brings up complications such as contractures, muscle wastage, stiff joints, bedsores and respiratory problems. Disability can be due to HIV as a disease, secondary side effects and the side effects of treatment. This establishes the need for physiotherapeutic care4/30/202027Stay home stay safe

28. Physiotherapy in acute stagePhysiotherapists are experts in body movements and exercises that’s why they take a primary role in treatment of HIV patients both during acute and rehabilitation phases. In acute stage Physiotherapists are involved in the following ways depending on the presentation of the patient:Maintaining clear the pulmonary system by clearing chest secretions and expanding lung tissue if there is a collapse Maintaining the normal joint ranges and increasing circulation to dependant limbs by doing passive mobilization.Postural correction to prevent any deformities.4/30/202028Stay home stay safe

29. Physiotherapy in Chronic Stage or Rehabilitation StagePhysiotherapists work with all health providers as a team like Doctors, Nurses, Occupational therapists, and Social workers The advances in the treatment of HIV have resulted in increased life expectance in people living with HIV as long as they have access to the new treatment regime.But due to the medicinal or disease effects, the chances of these people developing disability are very high. A wide range of problems are likely arising from neurological, musculoskeletal and painful syndromes. 4/30/202029Stay home stay safe

30. Physiotherapy in Chronic Stage or Rehabilitation Stage cont’dAll these problems can be alleviated through Physiotherapy interventions by applying the following depending on the presentation of the patient:-Maintaining the normal joint ranges and increasing circulation to dependant limbs by doing passive mobilization.Stretching exercises as a prevention of painful contracturesRestoration of body image due to weight loss by strengthening wasted musclesPain management by using electrotherapyEndurance training Active mobilization through to independent walkingProvision of assistive device i.e. Crutches, walking sticks etcHealth promotion advicePostural correction to prevent any deformities4/30/202030Stay home stay safe

31. Thank you For any concern please contact me via ashuphysio123@gmail.com+251918298143+2519756266084/30/202031Stay home stay safe