AIDS.
This chapter gives a concise overview of the Acquired Immunodeficiency Syndrome (AIDS), with special emphasis on clinical aspects relevant to rehabilitation professionals. AIDS is a novel form of an acquired immune deficit now known to be caused by the recently recognized Human Immunodeficiency Virus (HIV). Symptoms result from the direct effects of the virus on the immune system and the nervous system, which appear to be the primary targets. Much of the morbidity and mortality, however, is caused by opportunistic infections which occur in patients unable to mobilize the appropriate immune defenses against them. Characteristic, but previously rare, neoplasms also occur due to a failure of immune regulation. Improved medical care, however, has changed AIDS from a rapidly fatal disease to one where survival may be prolonged. The rehabilitation setting, the physical disability caused by AIDS, along with the psychosocial and economic impact of the disease on the patient have become increasingly important. Fatigue, decreased endurance, weight loss, edema, blindness and swallowing difficulties may all contribute to functional impairment. Neurological involvement is frequent and may cause dementia, hemiplegia, spastic paraparesis, painful neuropathies and proximal or distal muscle weakness. The clinical features and functional impact of these symptoms on the patient with AIDS is discussed, and the appropriate rehabilitation interventions outlined. Psychosocial and vocational issues are addressed as they pertain to the different clinical presentations.
Senior Staff Physiatrist, Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC.
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O'Connell