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CASE STUDY

CASE STUDY

F.M. is a 44-year-old man who has been human immunodeficiency virus (HIV) positive for 10 years. On his most recent physician visit, he was hyperglycemic and dyslipidemic. Although his weight has been stable over the past several years, he noted that his legs appear thinner and his waist is definitely larger. The patient’s antiretroviral therapy regimen includes two nucleoside reverse transcriptase inhibitors, a nonnucleoside reverse transcriptase inhibitor, a protease inhibitor, and a pharmacokinetic booster. Since his HIV infection has responded very well to this drug regimen, F.M.’s physician is currently reluctant to switch to a protease inhibitor-sparing regimen. Instead, she has referred him to a physical therapist to assess the efficacy of a nonpharmacological approach to treating the hyperglycemia, dyslipidemia, and lipodystrophy.

REHABILITATION FOCUS

Viral infections such as HIV or hepatitis B virus (HBV) are chronic. Once acquired, the individual rarely eliminates the virus. Such chronic viral infections pose a unique problem in healthcare. These diseases may accelerate aging, resulting in physical decline beyond that based on the person’s chronologic age. Pharmacotherapy for such infections is lifelong. Although many antiviral agents limit the extent of systemic damage, especially when initiated early during infection, very few can completely cure viral infections. Patients taking antiviral agents also face challenges in adhering to complicated drug regimens. For example, antiretroviral therapy (ART) regimens generally require persons infected with HIV that demonstrate acquired immunodeficiency syndrome (AIDS) to take multiple drugs—antiviral drugs and drugs for comorbidities—every day on a chronic basis. Antihepatitis B drug regimens are also complex and chronic, as are some antiherpetic drug regimens. In addition, the adverse effects of systemic antiviral agents may cause some patients to abandon treatment.

Most research on debilitation associated with viral infections has focused on the HIV/AIDS population. These individuals demonstrate higher rates of pain disorders, physical deconditioning, psychiatric disorders, and cardiovascular and metabolic diseases. These dysfunctions likely result from both the disease process and the pharmacotherapy. Individuals with chronic HIV infection often seek additional nonpharmacological therapies to improve health and fitness, body image, reduce metabolic and cardiovascular comorbidities, and decrease chronic pain and depression. Adherence to exercise programs has demonstrated beneficial effects in all these areas. A systematic review found that 41-50 minutes of aerobic exercise 3-4 times per week was associated with higher CD4 cell counts, but not reduced viral load. Resistance programs have demonstrated higher adherence rates than aerobic programs. However, individuals with HIV/AIDS demonstrate higher dropout rates from physical intervention programs compared to other populations with similar comorbidities.

Therapists must be sensitive to the profound impact chronic infectious diseases and the antiviral drugs used to treat them have on patients’ abilities to participate in therapy sessions and to achieve some therapy goals. Adverse drug reactions (ADRs) may delay treatment sessions. In the inpatient setting, frequent brief sessions may be more effective and tolerable than a single longer session. Pain ...

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