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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 have an impact on 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
(including low energy and poor sleep)

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.