Włodzisław Kuliński, Anna Muszyńska, Jerzy Kruszewski

Włodzisław Kuliński, Anna Muszyńska, Jerzy Kruszewski – Problems in physico- and physiotherapy of patients in the course of HIV infection and AIDS infection. Fizjoterapia Polska 2002; 2(1); 68-70

Abstract
In 1989, the first case was diagnosed of the disease later called acquired immune deficiency syndrome (AIDS). According to WHO data, by the end of 1998 over 30 million persons around the world were known to be infected by the human immunodeficiency virus (HIV); every day 16,000 new cases of HIV infection are reported, and several million people have died of AIDS. In Poland, by the end of 1999 several thousand persons had been infected with HIV, of whom several hundred had been diagnosed with AIDS. From the moment of infection to the full development of the disease takes about ten years. AIDS is spreading on an epidemic scale. Pharmalogical treatment is imperfect and only serves to slow the progress of the infection and delay the onset of AIDS. In the development of the disease we observe the appearance of changes in the central and peripheral nervous systems, caused directly by the action of the virus and by the worsening impairment of cell immunity. Multi-focal leukoencephalopathy is found in the brain, and in the peripheral nervous system there are symptoms of sensory polyneuropathy, followed by demyelinating neuropathy and symptoms of damage to multiple peripheral nerves. In practice, peripheral neuropathy occurs in conjection with subacute encephalitis and paresis of the cranial nerves, primarily V, VII and VIII. Lesions in the vicinity of the spinal cord cause weakening of muscle strength, sphincter disorders, and progressive plegia of the limbs. In many patients we also observe symptoms in the joints. In the physico- and physiotherapeutic treatment of these patients we recommend variable low-frequency magnetic fields for subacute encephalitis with involvement of the cranial nerves (the article specifies the parameters for the procedures and the exposure time, also for patients with symptoms of peripheral neuropathy and limb plegia). The possibilities of selective physicotherapy by other means is discussed. Physical therapy procedures are also presented in the course of joint disorders, and kinesitherapeutic procedures are discussed. In the balance of the article the detailed rules for personal hygiene in handling these patients are discussed. The risk of transmitting HIV infection during physio- and physiotherapeutic procedures has been estimated at 5-10%. We have not had much experience in Poland with managing this group of patients. This article should be regarded as an attempt to raise problems which should be solved in cooperation.

Key words:
Physical Medicine, rehabilitation, prevention