RESUMEN
We investigated the effects of exercise training on bone mineral density (BMD) in people living with Human Immunodeficiency Virus (PLHIV). Pubmed, Scopus, Cochrane Library, and ScienceDirect databases were searched for trials investigating exercise training-induced changes in BMD of PLHIV at baseline vs. post-intervention assessed by dual-energy X-ray absorptiometry (DXA). Hedge effect sizes (ES) were calculated incorporating fixed effects for BMD variation assumptions. Disaggregated comparisons were performed for trials with more than one intervention or BMD site assessment. Seven trials included 210 PLHIV and 35 non-HIV-infected controls. Methodological quality evaluated using the Physiotherapy Evidence Database (PEDro) scale ranged from poor to moderate. Interventions applied isolated resistance, combined aerobic and resistance, and multimodal exercise protocols performed 3 d/wk for 12-to 104 week. One controlled and another uncontrolled trial presented significant effects, reporting improvements at the femoral neck and total (ES 2.14 and 0.49, respectively). Magnitude of those specific ES influenced the overall effect (controlled and uncontrolled trials), which was small but significant (k = 12, ES 0.277, 95% confidence interval 0.120-0.434). Resistance training may promote favorable adaptations in BMD of PLHIV, particularly in femur. Future research should elucidate the optimal dose-response relationship and physiological mechanisms underlying exercise-induced adaptations on the BMD of PLHIV.
Asunto(s)
Densidad Ósea , Ejercicio Físico , Infecciones por VIH , Adulto , Femenino , Humanos , Masculino , Absorciometría de Fotón , Ejercicio Físico/fisiología , Terapia por Ejercicio/métodos , Infecciones por VIH/rehabilitación , Entrenamiento de Fuerza/métodosRESUMEN
People living with HIV are at an increased risk of developing cognitive deficits. Physical exercise is an important strategy to improve the brain health of people living with HIV. This randomized, controlled study aimed to investigate the acute effect of a single resistance exercise session on the cognitive function of people living with HIV. Twenty-three people living with HIV were randomized (1:1) to a control group (n = 12) or the exercise group (n = 11). Cognitive function was assessed by the Stroop test and the Trail Making Test. The exercise group was evaluated before and after the exercise session; meanwhile, the control group was evaluated before and after a 40-minute rest period. No statistical difference was found on the effect of exercise on cognitive function (p > 0.05). This result suggests that one session of resistance exercise was not capable of improving the cognitive function of people with HIV.
Asunto(s)
Cognición/fisiología , Ejercicio Físico/fisiología , Infecciones por VIH/rehabilitación , Entrenamiento de Fuerza/métodos , Adulto , Trastornos del Conocimiento , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Introducción: La rehabilitación se presenta como una estrategia eficaz que puede usarse para hacer frente a las deficiencias, discapacidades y minusvalías que van presentando los pacientes con virus de inmunodeficiencia humana. Las dificultades psicosociales y cognitivas ocasionadas por la enfermedad unidas a la debilidad muscular incapacitan al paciente, tanto mental como físicamente, para llevar a cabo las actividades de la vida diaria. Objetivo: Ampliar los conocimientos a todos los profesionales de la salud sobre el manejo rehabilitador de los pacientes con virus de inmunodeficiencia humana. Métodos: Se realizó una revisión del tema en las bases de datos Lilacs, Ebsco, Cochrane Library y Pubmed. La estrategia de búsqueda se desarrolló en el período comprendido entre mayo y julio de 2019. Conclusiones: El propósito de la rehabilitación es que el paciente tenga las mejores posibilidades de confort y productividad, cualquiera que sea su expectativa de vida(AU)
Introduction: Rehabilitation is presented as an effective strategy that can be used to confront the deficiencies, disabilities and handicaps affecting patients with human immunodeficiency virus. The psychosocial and cognitive difficulties caused by the disease, together with muscle weakness, incapacitates the patient, both mentally and physically, to carry out the activities of daily life. Objective: To extend the knowledge to all health professionals about the rehabilitative management of patients with human immunodeficiency virus. Methods: A review of the topic was carried out in the databases of Lilacs, Ebsco, Cochrane Library and Pubmed. The search strategy was developed in the period between May and July 2019. Conclusions: The purpose of rehabilitation is for the patient to have the best possibilities of comfort and productivity, whatever their life expectancy may be(AU)
Asunto(s)
Humanos , Masculino , Femenino , Calidad de Vida , Infecciones por VIH/rehabilitación , Modalidades de FisioterapiaRESUMEN
Background: An observational study was conducted in Maputo, Mozambique, to investigate trends in prevalence of HIV drug resistance (HIVDR) in antiretroviral (ART) naïve subjects initiating highly active antiretroviral treatment (HAART). Methodology/principal findings: To evaluate the pattern of drug resistance mutations (DRMs) found in adults on ART failing first-line HAART [patients with detectable viral load (VL)]. Untreated subjects [Group 1 (G1; n=99)] and 274 treated subjects with variable length of exposure to ARV´s [6-12 months, Group 2 (G2;n=93); 12-24 months, Group 3 (G3;n=81); >24 months (G4;n=100)] were enrolled. Virological and immunological failure (VF and IF) were measured based on viral load (VL) and T lymphocyte CD4+ cells (TCD4+) count and genotypic resistance was also performed. Major subtype found was C (untreated: n=66, 97,06%; treated: n=36, 91.7%). Maximum virological suppression was observed in G3, and significant differences intragroup were observed between VF and IF in G4 (p=0.022). Intergroup differences were observed between G3 and G4 for VF (p=0.023) and IF between G2 and G4 (p=0.0018). Viral suppression (<50 copies/ml) ranged from 84.9% to 90.1%, and concordant VL and DRM ranged from 25% to 57%. WHO cut-off for determining VF as given by 2010 guidelines (>5000 copies/ml) identified 50% of subjects carrying DRM compared to 100% when lower VL cut-off was used (<50 copies/ml). Length of exposure to ARVs was directly proportional to the complexity of DRM patterns. In Mozambique, VL suppression was achieved in 76% of individuals after 24 months on HAART. This is in agreement with WHO target for HIVDR prevention target (70%). Conclusions: We demonstrated that the best way to determine therapeutic failure is VL compared to CD4 counts. The rationalized use of VL testing is needed to ensure timely detection of treatment failures preventing the occurrence of TDR and new infections.
Asunto(s)
Humanos , Animales , Masculino , Femenino , Adulto , Infecciones por VIH/rehabilitación , VIH-1/efectos de los fármacos , Terapia Antirretroviral Altamente Activa , Antirretrovirales/uso terapéutico , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Prevalencia , VIH-1/fisiología , VIH-1/genética , Insuficiencia del Tratamiento , Recuento de Linfocito CD4 , Carga Viral/efectos de la radiación , Carga Viral/genética , Farmacorresistencia Viral , Farmacorresistencia Viral/genética , Interacciones Huésped-Patógeno , Atención Ambulatoria , Genotipo , MutaciónRESUMEN
BACKGROUND: Elderly people present alterations in body composition and physical fitness, compromising their quality of life. Chronic diseases, including HIV/AIDS, worsen this situation. Resistance exercises are prescribed to improve fitness and promote healthier and independent aging. Recovery of strength and physical fitness is the goal of exercise in AIDS wasting syndrome. OBJECTIVE: This study describes a case series of HIV-positive elderly patients who participated in a progressive resistance training program and evaluates their body composition, muscular strength, physical fitness and the evolution of CD4+ and CD8+ cell counts. METHODS: Subjects were prospectively recruited for nine months. The training program consisted of three sets of 8-12 repetitions of leg press, seated row, lumbar extension and chest press, performed with free weight machines hts, twice/week for one year. Infectious disease physicians followed patients and reported all relevant clinical data. Body composition was assessed by anthropometric measures and dual-energy x-ray absorptiometry before and after the training program. RESULTS: Fourteen patients, aged 62-71 years old, of both genders, without regular physical activity who had an average of nine years of HIV/AIDS history were enrolled. The strengths of major muscle groups increased (74%-122%, p=0.003-0.021) with a corresponding improvement in sit-standing and walking 2.4 m tests (p=0.003). There were no changes in clinical conditions and body composition measures, but triceps and thigh skinfolds were significantly reduced (p=0.037). In addition, there were significant increases in the CD4+ counts (N=151 cells; p=0.008) and the CD4+/CD8+ ratio (0.63 to 0.81, p=0.009). CONCLUSION: Resistance training increased strength, improved physical fitness, reduced upper and lower limb skinfolds, and were associated with an improvement in the CD4+ and CD4+/CD8+ counts in HIV positive elderly patients without significant side effects.
Asunto(s)
Composición Corporal/inmunología , Infecciones por VIH/inmunología , Infecciones por VIH/rehabilitación , Fuerza Muscular/inmunología , Aptitud Física/fisiología , Entrenamiento de Fuerza , Absorciometría de Fotón , Anciano , Composición Corporal/fisiología , Relación CD4-CD8 , Femenino , Infecciones por VIH/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular/fisiología , Estudios ProspectivosAsunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infecciones por VIH/diagnóstico , Neoplasias/diagnóstico , Infecciones por VIH/rehabilitación , Síndrome de Inmunodeficiencia Adquirida/rehabilitación , Neoplasias/rehabilitación , Terapia OcupacionalRESUMEN
BACKGROUND: Elderly people present alterations in body composition and physical fitness, compromising their quality of life. Chronic diseases, including HIV/AIDS, worsen this situation. Resistance exercises are prescribed to improve fitness and promote healthier and independent aging. Recovery of strength and physical fitness is the goal of exercise in AIDS wasting syndrome. OBJECTIVE: This study describes a case series of HIV-positive elderly patients who participated in a progressive resistance training program and evaluates their body composition, muscular strength, physical fitness and the evolution of CD4+ and CD8+ cell counts. METHODS: Subjects were prospectively recruited for nine months. The training program consisted of three sets of 8-12 repetitions of leg press, seated row, lumbar extension and chest press, performed with free weight machines hts, twice/week for one year. Infectious disease physicians followed patients and reported all relevant clinical data. Body composition was assessed by anthropometric measures and dual-energy x-ray absorptiometry before and after the training program. RESULTS: Fourteen patients, aged 62-71 years old, of both genders, without regular physical activity who had an average of nine years of HIV/AIDS history were enrolled. The strengths of major muscle groups increased (74 percent-122 percent, p=0.003-0.021) with a corresponding improvement in sit-standing and walking 2.4 m tests (p=0.003). There were no changes in clinical conditions and body composition measures, but triceps and thigh skinfolds were significantly reduced (p=0.037). In addition, there were significant increases in the CD4+ counts (N=151 cells; p=0.008) and the CD4+/CD8+ ratio (0.63 to 0.81, p=0.009). CONCLUSION: Resistance training increased strength, improved physical fitness, reduced upper and lower limb skinfolds, and were associated with an improvement in the CD4+ and CD4+/CD8+ counts in HIV positive elderly patients without ...
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Composición Corporal/inmunología , Infecciones por VIH/inmunología , Infecciones por VIH/rehabilitación , Fuerza Muscular/inmunología , Aptitud Física/fisiología , Entrenamiento de Fuerza , Absorciometría de Fotón , Composición Corporal/fisiología , Infecciones por VIH/fisiopatología , Fuerza Muscular/fisiología , Estudios ProspectivosRESUMEN
Atualmente, com o avanço nos tratamento, a infecção pelo HIV tem sido considerada como uma doença crônica, dando ao paciente uma maior expectativa de vida. Esta infecção tem a propensão, através da ação direta do vírus ou das doenças oportunistas e neoplasias, de envolver múltiplos órgãos e sistemas, produzindo uma grande variedade de condições debilitantes. O aumento da sobrevida associado à debilidade física conseqüente à doença pode comprometer a independência do paciente, tanto na mobilidade e autocuidado, como para o trabalho e produtividade. Conforme aumenta o número de pessoas infectadas, mais atenção precisa ser dada ao manejo da incapacidade física para proporcionar uma melhor qualidade de vida. Existe pouca pesquisa nesta área. Este estudo é uma revisão das estratégias fisioterapeuticas indicadas para prevenir ou retardar a incapacidade conseqüente à doença, mantendo a independência do paciente infectado pelo maior tempo possível. Nós concluímos que a fisioterapia tem um papel significativo em minimizar o déficit funcional melhorando a qualidade de vida.
Asunto(s)
Humanos , Sistema Nervioso Central , Infecciones por VIH/complicaciones , Infecciones por VIH/rehabilitación , Músculos/patología , Dolor , Especialidad de FisioterapiaRESUMEN
The impetus for this volume was a seemingly simple query by an Asian Minister of Health. In 1995, two of the editors of this volume met with the minister who articulated his desire to take action to prevent an HIV epidemic in his country, but stated that he did not know what course of action to take. He asked for information on what had been tried and proven successful elsewhere ... We felt, therefore, that it would be helpful to have a single volume that reviewed notable interventions implemented to date in developing countries, with the aim of describing the strategies they have employed, implementation problems and opportunities encountered, and successes or failures in terms of results achieved. Such a volume would be particularly helpful if written in a style accessible to diverse audiences and if an effort were expended to make it available to those working on HIV prevention in developing countries ... Our hope is that this volume will provide a forum for insights from important and creative HIV prevention efforts undertaken in the developing world to be shared with others whose work is inspired by the common desire to prevent the transmission of a virus that is responsible for untold suffering and devastating losses to individuals, families, communities, and nations. To a greater or lesser degree, in a direct or indirect fashion, and with more or less acute awareness, we have all experienced loss as a result of this pandemic. Preventing its further spread remains a matter of urgency for us all; learning from each others success and failures may contribute to our achieving this end (Eds.)
Asunto(s)
Humanos , Masculino , Femenino , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Países en Desarrollo , Infecciones por VIH/prevención & control , Infecciones por VIH/rehabilitaciónRESUMEN
AIDS: Hospice care relies on a variety of approaches to heal the mind and the soul, if not the body. While hospice care has been well developed in the United States and the United Kingdom, it has overlooked the crucial tool of psychiatry in responding to the mental health needs of dying residents. Many of the psychiatrist's roles are being handled by social workers, psychologists, and volunteers who are not trained to provide a deeper understanding of the complex picture of organic brain dysfunction, side effects of medical or psychiatric drugs, and psychiatric effects of opportunistic infections or cancers. Psychiatrists are trained to evaluate both the physical and psychiatric pieces of the whole patient picture, enabling a more precise understanding of the effects of dementia, grief, opportunistic infections, substance abuse, HIV treatment, and psychopharmacologic agents. The Psychiatrists Concerned About AIDS organization is working to overcome the exclusion of psychiatrists from acute and palliative care, and thus, resolve the split between psychiatry and hospice care.^ieng