3.1 – What are the rehabilitation interventions that address impairments common among people living with HIV?
3.1.1: Mental impairments
People living with HIV commonly experience mental impairments. These impairments include (but are not limited to) difficulties related to consciousness, orientation, intellect, energy and drive, sleep, attention, memory, emotion, perception, cognition and language.
These impairments may be caused by the HIV infection itself, one of the many opportunistic infections associated with HIV or side effects of various HIV-related medications. Pre-existing mental impairments may also be present which further impacts the rehabilitation of people living with HIV.
Rehabilitation interventions for these mental impairments include specific psychosocial techniques as well as general exercise and education. Potential causes of these impairments and rehabilitation interventions are shown in the table below.
Table 3.1.1: Clinical Aspects of Mental Impairments
| Impairments | Possible Etiologies | Rehabilitation Interventions1 (for details, see Section 3.3) |
|---|---|---|
HIV Cognitive-Motor Complex (also known as AIDS Dementia Complex or HIV Dementia) |
HIV (the virus itself) Opportunistic infections Side effects of medication |
|
Cognitive impairment (including memory loss) |
Hypoxia Cryptococcal meningitis TB meningitis Syphilis Neurovascular disease (stroke) Focal cerebral disease Vitamin deficiency (e.g., B12, B6) Electrolyte abnormalities Pain-related |
|
Psychological disorders (including depression, mood disorders, anxiety and delirium) |
Related to cognitive impairment Side effects of medication Psychosocial factors (e.g., stigma) Premorbid psychiatric disorders Post-traumatic stress disorder Pain-related |
|
Substance-related disorders |
Prescription medications (e.g., narcotics) Over-the-counter medications Street drugs: premorbid or current Alcohol: premorbid or current |
|
Fatigue |
Nutritional deficiencies Chronic diarrhea (malabsorption) Anemia (pre-existing, HIV or medication-related) Side effects of medication Hormone-related (e.g., thyroid, adrenal) Psychological (e.g., depression, anxiety) Chronic pain |
1Choice of rehabilitation interventions will depend on patient assessment and available resources.
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