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4.3.7 – Functions of the cardiovascular, haematological, immunological and respiratory systems

Cardiovascular

As children with HIV are living longer, cardiovascular complications are becoming more prevalent and contribute significantly to the morbidity and mortality. It is estimated that over 90% of children with HIV will have some form of cardiovascular problem.11

Most children are initially asymptomatic and may present with a range of diagnoses. Children most at risk for cardiovascular problems are those who present with encephalopathy, wasting and low CD4 counts.

Cardiovascular symptoms may be missed or thought to be due to respiratory or other infections. Regular screening of children, a healthy diet and regular exercise can help cardiac disease.

Haemotological

  • Most children living with HIV have problems with their haemotological systems.
  • These can be caused directly by HIV but may also be due to poor nutrition or side effects of medication.
  • These conditions are usually asymptomatic but may become life threatening.

Immunological

  • The primary problem resulting from HIV infection is dysfunction of the immune system.
  • HIV affects the infected immune cells directly and causes damage.
  • It also damages cells which are not directly infected and causes a generalized response to host cell infection.

Potential causes of these impairments and rehabilitation interventions are shown in the table below.

Table 4.3.7: Clinical Aspects of Cardiovascular, Haematological, Immunological and Respiratory Impairments

Impairments Possible Etiologies Rehabilitation Interventions10
Cardiovascular

HIV

Left ventricular abnormalities

Dilated cardiomyopathy

Myocarditis

Pericarditis

Rhythm disturbances

  • Assess heart rate and blood pressure before and after any exercise
  • Monitor levels of dyspnea (breathlessness) during exercise
  • Take complaints of dizziness and chest pain seriously
  • Refer to a doctor for a full cardiac assessment including echocardiograms if symptoms persist
Immunological

HIV

  • Rehabilitation cannot directly improve the immunological status of a patient. However there are aspects of rehabilitation that must be taken into consideration:
    • Maintain strict infection control in order to protect the immunocompromised child from secondary infections
    • Be aware of the degree of immunocompromise and adapt your treatment according to how ill the child is at this time. As with adults, children may present with periods of decreased immunity and episodic disability (see Section 1.4).

10Choice of rehabilitation interventions will depend on patient assessment and available resources.

11Dadlani G and Lipshultz S. 2005. Cardiac problems. In :Textbook of Pediatric HIV Care edited by Zeichner S and Read J. Cambridge