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Introduction to Benefits of Exercise for People with HIV/AIDS

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) were unknown prior to 1982, but since then have grown to become a global epidemic. As of 2007, there were approximately 65 million people living with HIV/AIDS worldwide, with over a million living in the United States. The deadly virus claimed the lives of 3.2 million people in 2002 (World Health Organization, 2003) and over 25 million that have died from the disease. Despite advances in treatment, there is no cure for HIV/AIDS.

The financial cost of the disease is immense. The Bush administration announced the Emergency Plan for AIDS Relief, a five-year, $15 billion initiative in fiscal year 2003 for U.S. international spending to combat HIV/AIDS. This amount, combined with healthcare costs, expenditures of other national governments, private funding, and allocations of worldwide organizations results in billions of dollars spent on HIV/AIDS treatment and research each year. The financial cost of this disease is certain to grow, as the numbers of diagnoses continue to increase.

The HIV virus is transmitted through blood-to-blood contact, across infected mucous membranes, or perinatally. The most common forms of transmission are unprotected sexual contact and intravenous drug use, in which needles are shared. Once a person is infected with the virus, the HIV replicates itself in lymphoid tissue and slowly destroys CD4 positive T-helper cells, thus weakening the immune system. A patient infected with the virus can be asymptomatic for as long as 10 to 15 years, but eventually the virus will destroy enough CD4 cells to make the infected person susceptible to infections he or she would not normally be susceptible to (Schmitz, Layne, and Roubenoff, 2002). A diagnosis of AIDS is made once a person's CD4 cells reach a count below 200 cells/mm3, or if a person contracts a condition from a list of 26 conditions defined by the Centers for Disease Control (CDC Link), which include many opportunistic infections (Centers for Disease Control, 2003). Prior to the late 1990s, persons with an AIDS diagnosis had a survival rate of approximately 2 years.

Today, highly active antiretroviral therapy (HAART) has dramatically altered the survival rate of persons with HIV/AIDS in countries where such treatment is available. However, with the advent of HAART, new problems have emerged. Aside from complicated dosing regimens, HAART is thought to bring about metabolic changes, which result in abnormal fat distribution as well as cholesterol and glucose abnormalities. In addition, there are many conditions associated with HIV/AIDS, including nausea, vomiting, dry mouth, fatigue, rash, weight loss or gain, peripheral neuropathy, insomnia, depression, and gastrointestinal problems (National Institute of Allergy and Infectious Disease, 2002). These associated conditions are a result of the virus itself, medication, or a combination.

Two conditions related to HIV/AIDS that are common to the disease are lipodystrophy and muscle wasting. Lipodystrophy is a disturbance in the way the body produces, uses, and distributes fat. In persons with HIV/AIDS, common symptoms include a loss of fat in the face, arms, legs, and buttocks, and a gain of fat in the abdomen, behind the neck, and/or in the breasts. Some people with lipodystrophy also exhibit high cholesterol, triglycerides, and blood glucose levels (Brewi, 2001). The cause or causes of lipodystrophy are unknown. Theories surrounding the cause include hormonal levels, medication, insulin resistance, or that it is simply a complication of living with HIV that is now emerging as people with HIV/AIDS are living longer. Generally, many people believe medications such as protease inhibitors cause lipodystrophy. However, it is important to note that some people who have never taken protease inhibitors have developed lipodystrophy (Cichocki, 2000). The danger in lipodystrophy is that it can lead to diabetes, high blood pressure, or heart disease. Medical treatment includes switching antiretroviral medications, taking medication to lower blood glucose, triglycerides, and cholesterol, hormone therapy to help decrease fat, or liposuction surgery (Brewi, 2001).

Muscle wasting involves involuntary weight loss of ten percent of baseline body weight. In wasting syndrome, the muscles waste away and the immune system is weakened. This is dangerous to the HIV/AIDS patient because it often leads to an increased susceptibility of developing opportunistic infections, and can lead to death. Wasting syndrome can be due to either malnourishment or metabolic disturbance. Some people living with HIV/AIDS may decrease their food intake due to poor appetite, problems with the mouth, throat or esophagus, fatigue, weakness, nausea, diarrhea, or they may have nutrient malabsorption due to medication. Possible causes of wasting due to metabolic disturbance include increased resting energy expenditure, tissue destruction, altered utilization and excretion of nutrients, and hypogonadism (Brewi, 2001).

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This fact sheet was last updated on 03-01-2007.