Physical Therapy Guide to HIV Disease and AIDS
People with HIV can live longer and lead more active lives than they could 40 years ago. This is due to advances in antiretroviral therapy (referred to as ART). With successful use of ART, many people with HIV can have the same life expectancy as people without the disease. Some people may experience side effects from ART. As they live longer, some may develop other HIV-related medical conditions. They also can develop health conditions related to aging. Physical therapists are qualified to diagnose and treat many of the physical problems linked to ART, or that develop over time in people living with HIV.
- Develop and adjust physical therapy treatment plans based on a person’s HIV disease status, any ART side effects, and other illnesses that may exist.
- Provide customized exercise and pain management programs.
- Help people with all stages of HIV prevent or reduce chronic pain and address movement or functional problems.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Are HIV Disease and AIDS?
HIV disease develops when the HIV retrovirus invades the body. The virus infects cells known as CD4 cells (white blood cells that fight infection). HIV is most commonly passed from person to person through:
- Unprotected sex.
- Exposure to infected blood.
- Needle-sharing or accidental punctures.
- Mother-to-child transmission during pregnancy, childbirth, or breastfeeding.
AIDS, or Acquired Immune Deficiency Syndrome, is the advanced stage of HIV disease. AIDS develops over time in patients who are not receiving ART. Over time, a person with AIDS develops a weakened immune system. With a weakened immune system, the body cannot fight infections. These infections can then become serious and life-threatening.
While doctors provide treatment for HIV itself, physical therapists can treat many HIV-related problems, including:
- Peripheral neuropathy (pain, a burning feeling, and numbness or tingling in the arms, legs, or feet). This results from nerve damage.
- Chronic pain.
- Muscle weakness.
- Muscle or joint stiffness.
- Balance problems.
- Trouble walking or using stairs.
- Problems doing work, sports, or recreational activities.
- Weight changes.
Signs and Symptoms
After an HIV infection, a person might develop flu-like symptoms for a period of days or weeks. These symptoms can include fever, headache, sore throat, swollen glands, or a rash. However, some people may experience no symptoms at all.
After about three weeks, an HIV antibody test will show that an infected person is HIV positive. Even when a person is HIV positive, they might remain symptom-free for years. If left untreated, however, HIV will progress. People with HIV may begin to have symptoms such as:
- Swollen lymph nodes.
- Weight loss.
- Night sweats.
- Cough or shortness of breath.
If the HIV infection is left untreated, advanced disease, or AIDS, usually develops within 10 years. Advanced disease makes you more vulnerable to infections. AIDS symptoms may include:
- Night sweats.
- Chronic diarrhea.
- White spots or lesions on the tongue or in the mouth.
- Skin rashes.
- Weight loss.
- Cognitive changes, such as confusion or memory problems.
- Blurred and altered vision.
When ART is successful, people do not usually get opportunistic infections. The treatment keeps the virus in check. However, the side effects of treatment — or simply living with HIV for a long time — can lead to health problems. For example, persons with HIV might develop:
- Peripheral neuropathy — nerve damage that results in pain, a burning feeling, and numbness or tingling in your arms or legs.
- Muscle and joint aches and/or pain.
- High blood pressure.
- High blood sugar.
- Weakness and difficulty doing normal day-to-day activities.
- Weight changes.
Having HIV disease may make it hard to treat other health conditions. Aging-related common conditions, injuries, or problems also might affect long-term survival. This is especially true in cases of advanced HIV disease.
Symptoms of HIV disease and AIDS are described in more detail on the Centers for Disease Control and Prevention website.
How Is It Diagnosed?
HIV infection is diagnosed by a blood test that looks for HIV or antibodies to HIV. There are over-the-counter tests available at local pharmacies that can determine if you are HIV positive. It is important to meet with a doctor for proper treatment with ART if you test positive.
How Can a Physical Therapist Help?
HIV infections and the side effects from HIV treatment can cause pain. They also can cause conditions that affect normal movement and endurance. HIV also can reduce your ability to do work or take part in recreational activities. This is where a physical therapist can help. While physical therapists do not treat HIV directly, they treat the movement and functional problems that people with HIV have.
People with HIV disease also can experience injuries or age-related conditions, such as arthritis, just the same as people without HIV. These are all problems that can be treated by a physical therapist. Your physical therapist's overall goal is to improve your quality of life and help you stay active at home, at work, and in your community.
Your physical therapist will conduct a full evaluation to identify the causes of any pain. They also will assess any movement problems that affect your ability to do physical activity. They will select treatments to address your specific needs. These can help relieve pain and improve heart health, balance, and the ability to do daily activities.
While there is currently no cure or vaccine for HIV, staying on ART can prevent some HIV-related complications. ART can help you live a long, healthy life. Working with a physical therapist can help you improve and maintain your fitness and function. Your physical therapist will design a treatment program to help you meet your specific goals.
Physical therapist treatment may address:
Pain levels. Physical therapists use hands-on therapy, exercise, or treatments such as electrical stimulation to help decrease pain. Your physical therapist also may teach you gentle exercises or techniques to reduce your pain. These may reduce or eliminate the need for pain medicines, such as opioids.
Movement. Your physical therapist will choose activities and treatments to help restore normal movement to any stiff joints and muscles. These might begin with passive motions that the physical therapist performs for you. The goal is to gently move your joints and muscles so that you can progress to doing exercises and stretches yourself.
Exercise. Your physical therapist will teach you exercises to do at home. They will be based on your needs to help speed recovery from the specific problems that brought you to physical therapy.
Daily activities. Your physical therapist will discuss your activity challenges and goals. They will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you reach your goals in the safest, fastest, and most effective way possible.
Flexibility. Your physical therapist will determine if any of your muscles or joints are tight. They will begin to gently stretch them and teach you how to stretch them on your own.
Walking. Your physical therapist will help improve your ability to walk, and to do so safely. They will use methods such as strengthening exercises, walking training, and balance activities. They also may recommend other ways to make it easier or safer for you to walk, such as using a walker or a cane.
Endurance. People with advanced HIV disease may have a decreased ability to process oxygen (aerobic capacity). This can cause fatigue. Your physical therapist can assess your aerobic capacity. They will determine the best activities and exercises to help you improve your endurance and speed your return to normal activities. They may have you walk or use exercise equipment such as treadmills, elliptical machines, rowing machines, or stationary bikes.
Strength. Long-term HIV infection and treatment can result in the loss of muscle strength and mass. Research shows that exercise using weights is effective in increasing strength in people with HIV. Your physical therapist will work with you to set up an exercise program specific for you. They will adjust your program over time to address any changes in your condition. Certain exercises will aid healing at each stage of recovery. Your physical therapist will teach you the correct exercises and equipment to use to recover muscle strength and mass.
Coordination. Your physical therapist will help you regain and improve your coordination and agility. This will help you do household, community, and physical activities with greater ease.
Balance. Your physical therapist will assess your balance. They will choose specific exercises that you can do in the clinic and at home to improve your balance and prevent falls. Your physical therapist also may teach you how to use a cane or walker for balance when standing or moving around.
Body weight. Your physical therapist will create an exercise and physical activity program tailored for you. This will help you acquire and keep a healthy body weight. You also may work with a nutritionist or dietician to help you achieve your body weight goals.
Can This Injury or Condition Be Prevented?
HIV infection often can be prevented by practicing safe sex. Safe sex involves using latex condoms and/or medicines known as PrEP (pre-exposure prophylaxis). People who use injectable (intravenous or IV) drugs can prevent HIV by not sharing needles. Learn more about these and other forms of HIV prevention at the CDC website.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of physical conditions and injuries in people with HIV disease or AIDS. You may want to consider:
- A physical therapist with experience working with people with HIV.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurologic or oncologic physical therapy. These physical therapists have advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists in your area with these credentials and clinical expertise on Find a PT, a tool built by the American Physical Therapy Association.
General tips when you are looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapist for an appointment, be sure to ask about their experience in helping people with underlying HIV disease or AIDS.
- Be prepared to describe your symptoms in as much detail as possible during your first visit. Make a note of what makes your symptoms better or worse.
The American Physical Therapy Association believes that consumers should have access to information to help them make informed health care decisions and prepare them for their visit with a health care provider.
The following resources offer some of the best scientific evidence related to physical therapy treatment for people with HIV disease or AIDS. They report recent research and give an overview of the standards of practice both in the United States and internationally. They link to a PubMed* abstract that also may offer free access to the full text, or to other resources. You can read them or print out a copy to bring with you to your health care provider.
Bhochhibhoya A, Harrison S, Yonce S, Friedman DB, Ghimire PS, Li X. A systematic review of psychosocial interventions for older adults living with HIV. AIDS Care. 2021;33(8):971–982. Article Summary on PubMed.
Brown DA, O'Brien KK, Josh J, et al. Six lessons for COVID-19 rehabilitation from HIV rehabilitation. Phys Ther. 2020;100(11):1906-1909. Article Summary on PubMed.
Pullen SD, Del Rio C, Brandon D, et al. Associations between chronic pain, analgesic use and physical therapy among adults living with HIV in Atlanta, Georgia: a retrospective cohort study. AIDS Care. 2020;32(1):65–71. Article Summary on PubMed.
Pullen SD, Acker C, Kim H, et al. Physical therapy for chronic pain mitigation and opioid use reduction among people living with human immunodeficiency virus in Atlanta, GA: a descriptive case series. AIDS Res Hum Retroviruses. 2020;36(8):670–675. Article Summary on PubMed.
Winias S, Radithia D, Savitri Ernawati D. Neuropathy complication of antiretroviral therapy in HIV/AIDS patients. Oral Dis. 2020;26 Suppl 1:149–152. Article Summary on PubMed.
deBoer H, Andrews M, Cudd S, et al. Where and how does physical therapy fit? Integrating physical therapy into interprofessional HIV care. Disabil Rehabil. 2019;41(15):1768–1777. Article Summary on PubMed.
Ibeneme SC, Irem FO, Iloanusi NI, et al. Impact of physical exercises on immune function, bone mineral density, and quality of life in people living with HIV/AIDS: a systematic review with meta-analysis. BMC Infect Dis. 2019;19(1):340. Article Summary on PubMed.
Ibeneme SC, Omeje C, Myezwa H, et al. Effects of physical exercises on inflammatory biomarkers and cardiopulmonary function in patients living with HIV: a systematic review with meta-analysis. BMC Infect Dis. 2019;19(1):359. Article Summary on PubMed.
Gomes-Neto M, Rodriguez I, Lédo AP, Vieira JP, Brites C. Muscle strength and aerobic capacity in HIV-infected patients: a systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2018;79(4):491–500. Article Summary on PubMed.
O'Brien KK, Tynan AM, Nixon SA, Glazier RH. Effectiveness of progressive resistive exercise (PRE) in the context of HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infect Dis. 2017;17(1):268. Article Summary on PubMed.
Mocumbi AO. Cardiac disease and HIV in Africa: a case for physical exercise. Open AIDS J. 2015;9:62–65. Article Summary on PubMed .
Bauer LO, Wu Z, Wolfson LI. An obese body mass increases the adverse effects of HIV/AIDS on balance and gait. Phys Ther. 2011;91(7):1063–1071. Article Summary on PubMed.
Fillipas S, Cherry CL, Cicuttini F, et al. The effects of exercise training on metabolic and morphological outcomes for people living with HIV: a systematic review of randomized controlled trials. HIV Clin Trials. 2010;11(5):270–282. Article Summary on PubMed.
Sandoval R, Runft B, Roddey T. Pilot study: does lower extremity night splinting assist in the management of painful peripheral neuropathy in the HIV/AIDS population? J Int Assoc Physicians AIDS Care (Chic). 2010;9:368–381. Article Summary on PubMed.
PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.