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

3.1.5: Functions of the digestive, metabolic and endocrine systems

People living with HIV may present with impairments related to digestion, endocrine function and weight maintenance (both excessive weight loss and weight gain). 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.

Dietary advice and exercise prescription can be utilized as methods to assist people living with HIV with both weight gain and weight loss. Potential causes of these impairments and rehabilitation interventions are shown in the table below.

Table 3.1.5: Clinical Aspects of Digestive, Metabolic and Endocrine Impairments

Impairments Possible Etiologies Rehabilitation Interventions6
(for details, see Section 3.3)

Digestive dysfunction

HIV enteropathy

Secondary infections (e.g., MAC, cryptosporidium)

Obstruction (e.g., tumour)

Food intolerances

Medication-related

Endocrine dysfunction

Malignancy

Adrenal insufficiency

Hypogonadism

Hypothyroidism

Medication-related

Food intolerances

Weight loss

Anorexia secondary to physiological (e.g., oesophagitis, candida) or psychological causes

Dysphagia (e.g., due to candida, KS or CMV)

Malnutrition

Malabsorption

Malignancy

Infection and fever-related

Side effects of medication

Weight gain

Inactivity and deconditioning

Constipation

Side effects of medication

Weight redistribution

HIV-infection

Side effects of medication

Lipodystrophy

6Choice of rehabilitation interventions will depend on patient assessment and available resources.