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This retrospective study outlines interventions taken as a result of rehabilitation medicine consultation in persons hospitalized with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). The medical records of 30 persons with HIV infection consecutively referred for rehabilitation medicine consultation over a one-year period were reviewed. The sample was composed primarily of white, homosexual males with a mean age of 38.5 (SD, 8.5) years and a mean length of AIDS diagnosis of 14.6 (SD, 14.1) months. Rehabilitation medicine evaluation resulted in additional diagnoses in four cases (13.3%), prescriptions for new medications in 8 (26.7%), physical modalities/devices in 9 (30.0%) and referrals to occupational, physical and speech therapies in 26 (86.7%), 24 (80.0%) and 3 (10.0%) patients, respectively. Interventions were often directed toward deconditioning, painful peripheral neuropathy and fatigue. Mean survival after rehabilitation consultation was approximately 23 weeks. No intervention was novel or unusual suggesting that current knowledge is sufficient to manage much of the disability associated with HIV infection. This study concludes that rehabilitation medicine can contribute to the management of persons hospitalized with AIDS. Further research should address efficacy of intervention, fatigue as a source of disability and the value of early rehabilitation intervention.
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PMID:Rehabilitation medicine consultation in persons hospitalized with AIDS. An analysis of thirty cases. 847 49

This longitudinal study explored the meaning of hope, the influence of specific background characteristics on hope, and identified strategies that are used to foster hope in a convenience sample of 25 family caregivers of terminally ill family members from two hospice programmes using the technique of methodological triangulation (interview, Herth Hope Index and Background Data Form). Hope was defined as a dynamic inner power that enables transcendence of the present situation and fosters a positive new awareness of being. Six hope-fostering categories and three hope-hindering categories were identified based on the interview responses. With the exception of those providing care to a family member diagnosed with AIDS and those caregivers experiencing poor personal health, a high fatigue level, severe sleep deprivation and more than two concurrent losses, overall hope levels among participants were found to remain stable across the background variables. Across time, hope levels were found to be low at interview time one, rise significantly by time two and then level off for the remainder of the time. An understanding of hope from the perspective of the family caregiver could provide a basis upon which to develop interventions that foster hope.
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PMID:Hope in the family caregiver of terminally ill people. 849 1

The number of AIDS patients over age 60 has risen steadily in the past decade. The number of transfusion-acquired AIDS cases probably has peaked--or will soon peak. Homosexual (or bisexual) behavior remains the predominant risk factor for AIDS until the seventh decade. Disease progression appears to be more rapid in the elderly, although the observed shorter survival time may result from a delay in diagnosis. Symptoms of HIV infection are often nonspecific, such as fatigue, anorexia, weight loss, and decreased physical and cognitive function. The five most common opportunistic infections in older HIV-infected patients are Pneumocystis carinii pneumonia, tuberculosis, Mycobacterium avium complex, herpes zoster, and cytomegalovirus. A number of features of HIV-related dementia may help to distinguish it from Alzheimer's disease.
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PMID:HIV infection in older patients: when to suspect the unexpected. 850 Jul 75

Ten HIV-positive patients were given thyroid hormone in pharmacological doses. Two patients that had CD4 counts of 200 or higher responded well with gain in weight, energy, endurance and well-being within 6 months. During the same period, their CD4 counts rose to within normal limits and remained there. One patient has been well for 3 years and the other for 1 year. Six other patients with counts below 200 have had variable clinical improvements during the first 6 months but no change in CD4 counts. Thyroid therapy in pharmacological doses helps most patients with symptoms of fatigue or depression. At the same time, it may retard or prevent the progression from HIV infection to AIDS.
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PMID:Thyroid therapy in HIV-infected patients. 853 32

To assess the health values of patients infected with human immunodeficiency virus (HIV) and examine the relationships between their health values and health status at two points in time, the authors sought to determine whether patients' physical and mental health statuses were good predictors of how they valued their current state of health. One hundred thirty-nine patients with various stages of HIV infection were interviewed in a prospective cohort study based in a primary care practice of a community-based teaching hospital. Patients were interviewed twice at 6-month intervals using three health value measures--the time trade off, rating scale, and Quality of Well-being Scale--and three health status measures: the 18-item Mental Health Inventory, the Dyspnea-Fatigue Index, and the Medical Outcomes Study SF-36 Health Survey. The health status of HIV-infected patients was compromised and, with the exception of mental health, generally was worse among patients with more advanced HIV-infection. Rating scale and Quality of Well-being Scale scores were related inversely to disease stage, but time-trade off scores generally were higher regardless of disease stage. Health value measures showed moderate relationships with measures of physical functioning (r = 0.34-0.68) but only a fair relationship with mental health (r = 0.00-0.48). The health status of HIV-infected patients who remained asymptomatic or remained symptomatic but without developing acquired immunodeficiency syndrome (AIDS) changed little over 6 months, whereas the health status of patients with AIDS and of patients manifesting progression of HIV-infection deteriorated over time. In contrast, health values, particularly time-tradeoff scores, remained stable even in the face of changes in health status and disease progression. With the exception of mental health, the impact of HIV infection on health status tends to parallel the clinical stage of disease. Health values of HIV-infected patients, however, generally are high and correlate better with physical functioning than with mental health.
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PMID:Health values of patients infected with human immunodeficiency virus. Relationship to mental health and physical functioning. 855 11

Alcohol consumption as a cofactor in the progression of HIV infection was examined in 1,446 homosexual and bisexual HIV + men enrolled in the Multicenter AIDS Cohort Study who had a minimum of three visits. Two measures of drinking were employed: initial level, and pattern during the study period. Outcome measures included AIDS-related symptoms and AIDS diagnosis. Level of drinking at entry to the study was not significantly associated with either AIDS-related symptoms at final visit or with AIDS diagnosis. However, men who decreased drinking were more likely to report thrush, fatigue, weight loss, and diarrhea at their final visit. Most likely, these men decreased drinking as a result of failing health, not because their drinking pattern influenced symptom onset. These data support earlier reports that found no relationship between alcohol consumption and progression to AIDS.
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PMID:Alcohol consumption as a cofactor in the progression of HIV infection and AIDS. 859 Jun 17

To assess safety, antitumor response, and immunological and virological activity of interferon-alpha 2a and zidovudine combination therapy in patients with AIDS-related Kaposi's sarcoma, we conducted an open-label, Phase II, multicenter study. Sixty-three patients with biopsy-proven Kaposi's sarcoma and no previous interferon-alpha therapy received zidovudine 600 mg/day and interferon-alpha 2a 18 x 10(6) U/day. The median duration of follow-up was 49 weeks. Of 62 evaluable patients, 25 (40%; 95% confidence interval, 0.28-0.52) showed a complete (26%) or partial (15%) antitumor response. Eight of 30 patients (27%) with < 100 CD4 cells/mm3 and 17 of 32 patients (53%) with > or = 100 CD4 cells/mm3 had a response. The median time to response was 36 weeks. Of the 25 patients with a response, four developed tumor progression. The median duration of response was 22.4 weeks. Eight patients (13%) developed another AIDS-defining event and 13 (21%) died. The major toxicities included anemia (16%), neutropenia (27%), elevated serum transaminases (16%), weight loss (16%), malaise (14%), fatigue (14%), fever (10%), and headache (6%). Therapy with intermediate-dose interferon-alpha 2a and zidovudine resulted in tumor regression in patients with AIDS-related Kaposi's sarcoma who had a wide range of CD4 cell counts; this therapy was relatively well tolerated.
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PMID:A phase II study of recombinant human interferon-alpha 2a and zidovudine in patients with AIDS-related Kaposi's sarcoma. AIDS Clinical Trials Group. 860 Dec 24

Patients with advanced cancer or AIDS are frequently bothered by anorexia, decreased food intake, fatigue, weight loss, muscle wasting, and a decline in functional status. Nutritional support may afford these patients a better, although not longer life. Available interventions include nutrition counseling, homemade or commercial food supplements, appetite stimulants, enteral nutrition, and parenteral nutrition. Conservative cost estimates for these interventions range from $52/month for homemade supplements to $8,400/month for home parenteral nutrition. Clinicians need to be familiar with the benefits, risks, and costs of these therapies in order to suggest appropriate options.
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PMID:Costs and benefits of nutrition support in cancer. 860 60

To help clinicians better assess and treat functional disabilities in persons with acquired immunodeficiency syndrome (AIDS), the authors estimate empirical relations among biologic and physiologic variables, symptoms, and physical functioning in persons with AIDS. The sample of 305 persons with AIDS for this cross-sectional analysis came from three sites in Boston, Massachusetts: a hospital-based group practice, a human immunodeficiency virus clinic at a city hospital, and a staff-model health maintenance organization. Physical functioning, 10 AIDS-specific symptoms, and mental health were assessed by interview. Clinical diagnoses, comorbidities, health habits such as smoking, laboratory results, and selected medication use were assessed by chart review. Significant predictors of physical functioning P < 0.01, R2 = .58) in a multivariable regression model included energy/fatigue, neurologic symptoms, fever symptoms, a lower hemoglobin level, and current non-pneumonia bacterial infection. Ninety-six percent of the explained variance in physical functioning was accounted for by three symptom complexes: energy/fatigue, neurologic symptoms, and fever symptoms. Significant predictors of energy/fatigue in multivariable models included poorer mental health, lower white blood cell count, longer time since diagnosis, and weight loss (P < 0.01, R2 =.36). Significant predictors of neurologic symptoms included poorer mental health, weight loss, and no zidovudine use (P < 0.001, R2 = .30). Predictors of fever symptoms included poorer mental health, no zidovudine use, weight loss, and history of asthma or chronic obstructive pulmonary disease (P < 0.05, R2 = .25). In conclusion, symptom reports were strong predictors of physical functioning. Poorer mental health and weight loss were correlated consistently with worse symptoms, and not using zidovudine was correlated with worse neurologic and fever symptoms. These variables, and the others the authors identified, may represent mutable determinants of physical functioning in persons with AIDS, and potential targets for specific clinical interventions.
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PMID:Clinical predictors of functioning in persons with acquired immunodeficiency syndrome. 865 26

A 40-year-old male was admitted to the hospital with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP). Two months before admission the patient had a high fever, general fatigue and mild epigastic tenderness. On admission, physical examination revealed numerous small tumors on the head, gingiva, neck, nasal ala, anterior forehead, anterior thoracic, bilateral sole and bilateral lower limbs. At that time, the CD4 cell count was 130/microliters. Upper GI endoscopy was performed because of sever epigastralgia and hematemesis. The gastric mucosa was diffusely nodular and erythematous with bleeding. This biopsy showed Kaposi's sarcoma, and the same findings were obtained from the duodenum, rectum and skin, AIDS with related cutaneous and gastrointestinal KS and PCP was diagnosed. We performed a combination of chemotherapy and Interferon-alpha therapy, and the KS almost completely disappeared within 3 months.
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PMID:[Efficiency of combination chemotherapy and interferon-alpha therapy in a patient with AIDS-related cutaneous and gastrointestinal Kaposi's sarcoma]. 874 13


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