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3.1 – What are the rehabilitation interventions that address impairments common among people living with HIV?

3.1.2: Sensory functions and pain

Pain is commonly experienced by people living with HIV at all stages of the disease process. Pain prevalence ranges from 54% to 83%. This pain is often of moderate to severe intensity which has a negative impact on physical functioning.2

Pain rehabilitation techniques include electrotherapy modalities, cryotherapy and massage, as well as exercise prescription and education. Other sensory impairments, including difficulties related to sight, hearing and vestibular control are also experienced by people living with HIV. These may be managed by environmental modifications, provision of assistive devices and education.

These impairments may be caused by the HIV infection itself, one of the many opportunistic infections associated with HIV or toxicity or side-effects of various HIV-related medications. Potential causes of these impairments and rehabilitation interventions are shown in the table below.

Table 3.1.2: Clinical Aspects of Sensory Impairment

Impairments Possible Etiologies Rehabilitation Interventions3
(for details, see Section 3.3)

Visual loss
(including retinitis, retinal detachment, retinal vascular disease and blindness)

Viral (e.g., CMV, HSV, VSV)

Parasitic (e.g., Toxoplasmosis)

Fungal (e.g., PCP)

Bacterial (e.g., Cryptococcus)

Malignancy (e.g., Kaposi’s sarcoma, Burkitt’s lymphoma)


Cranial nerve involvement


Side effects from medication

Pre-existing (e.g., cataracts)

Auditory impairments (including hearing loss, tinnitus and otalgia)

HIV (the virus itself)

Opportunistic infections

Lesions in the central nervous system



Vestibular impairments (including dizziness and poor balance)

Otitis media

Side effects of medication

Visual impairment


Pain (acute and chronic)

Musculoskeletal pain (inflammatory or non-inflammatory)

Secondary processes, inactivity or deconditioning

Joint pain caused by bacterial infections, arthritis and medication

Central nervous system lesions (parasitic, fungal, bacterial, fungal or malignant)

Peripheral neuropathy (HIV or medication-related)

Myelopathy (e.g., secondary to CMV)

Systemic pain (e.g. malignancies, pleurisy, esophagitis, myocarditis, colitis)

Exacerbation of pain by lack of sleep, anxiety or depression

Impact of life situation (stress, finances, etc.)

Sensation changes (including numbness, burning or tingling)


Peripheral neuropathy

2Parker R, Stein D and Jelsma J, 2014. Pain in people living with HIV/AIDS: a systematic review. Journal of the International AIDS Society, 17:18719.

3Choice of rehabilitation interventions will depend on patient assessment and available resources.