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E-Module

An HIV and Rehab Resource

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  • About
    • 1 – What is this resource about and who is it for?
    • 2 – Why was this resource created?
    • 3 – How can this resource be used?
    • 4 – Can this resource be used for teaching?
    • 5 – How was this resource developed?
    • 6 – Who contributed to developing this adapted resource?
    • 7 – Who funded the development of this resource?
    • 8 – Disclaimer
  • Section 1
    • 1.1 How is “rehabilitation” defined in this resource?
    • 1.2 How can rehabilitation help people living with HIV?
    • 1.3 How can the World Health Organization’s “ICF” help us think about rehabilitation for people living with HIV?
    • 1.4 How can the Episodic Disability Model help us think about rehabilitation for people living with HIV?
    • 1.5 Who provides rehabilitation for people living with HIV?
    • 1.6 Do rehabilitation providers need special skills or training to care for people living with HIV? If so, what?
    • 1.7 What roles do rehabilitation providers have related to HIV?
    • 1.8 When is rehabilitation clinical intervention useful along the HIV care continuum?
  • Section 2
    • 2.1 What do rehabilitation professionals need to know about the stages of HIV infection?
    • 2.2 What do rehabilitation providers need to know about CD4 count and viral load?
    • 2.3 What is the impact of HIV on body systems and why does this matter for rehabilitation providers?
    • 2.4 Who might rehabilitation providers treat?
    • 2.5 What do rehabilitation providers need to know about antiretroviral therapies?
  • Section 3
    • 3.1 What are the rehabilitation interventions that address impairments common among people living with HIV?
    • 3.2 What are the rehabilitation interventions that can address the activity limitations and participation restrictions common among people living with HIV?
    • 3.3 More information on the rehabilitation interventions available for people living with HIV
    • 3.4 – What do rehabilitation providers need to know about their patients’ beliefs and use of traditional healers, spiritual leaders and alternative therapies outside the formal medical system?
  • Section 4
    • 4.1: Intersectionality Theory in the Context of Rehabilitation
    • 4.2: Children and Youth
    • 4.3: HIV and Aging
    • 4.4: Substance Use
    • 4.5: Trauma
    • 4.6: Racialized Populations
    • 4.7: Indigenous Populations
    • 4.8: HIV, Sex and Gender
    • 4.9: HIV and COVID-19
    • 4.10: Is HIV itself a disability?
  • Section 5
    • 5.1 What are outcome measures?
    • 5.2 Why is it important to use outcome measures during rehabilitation with people living with HIV?
    • 5.3 How do rehabilitation providers know if an outcome measure will be useful in practice?
    • 5.4 What are floor and ceiling effects in outcome measurement?
    • 5.5 What is the difference between generic and HIV-specific outcome measures?
    • 5.6 How should you decide which outcome measures to use?
    • 5.7 How do you access a copy of an outcome measure?
    • 5.8 What are rehabilitation-related outcome measures that can be useful for people living with HIV?
  • Case Studies
    • Case #1 – Acute Care, Cardiorespiratory and Neurological
    • Case #2 – Musculoskeletal – Knee Pain
    • Case #3 – Aging, Cognition, Community, Stroke
    • Case #4 – Complex Case – Musculoskeletal, Episodic, Cardiorespiratory
    • Case #5 – Diabetes, Neuropathy, Substance Use
    • Case #6 – Transition from Paediatric to Adult Care
    • Supplemental Case Studies without Leading Questions
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4.3: HIV and Aging

Due to the success of modern ART and an increase in the average age of new HIV diagnoses, the population of Canadians living with HIV is aging. Over 50% of Canadians living with HIV are now over the age of 50.1 In 2017, 23% of new HIV diagnoses in Canada were in people aged 50 years or older.2 People aging with HIV are living with age-related chronic health conditions (e.g., metabolic syndrome and cardiovascular disease), syndromes of aging (e.g., dementia and frailty) and side effects related to ART.3 In addition, non-ART polypharmacy is common among people aging with HIV and is associated with increasing risk of hospitalization and mortality.3 Disability issues experienced by those aging with HIV also include: uncertainty and worry about aging with a complex chronic disease, mental health challenges, pain, and stigma.4 Therefore, rehabilitation goals that are client-centered and that positively influence physical health and social participation may provide the most meaningful outcomes.5

Evidence-informed resources that address strategies for rehabilitation in those aging with HIV can be found at these links:

  • Siegler EL. Recognizing and Addressing Effects of Aging in Older Patients With HIV Clinical Guidelines Program.
  • ClinicalInfo.HIV.GOV. HIV and the Older Person.
  • American Academy of HIV Medicine, American Geriatrics Society, AIDS Community Research Initiative of America. Recommended Treatment Strategies for Clinicians Managing Older Patients with HIV
  • National Resource Center on HIV & Aging (USA). National Resource Center on HIV & Aging.
  • Montoya JL, Jankowski CM, O’Brien KK, Webel AR, Oursler KK, Henry BL, Moore DJ, Erlandson KM. Evidence-informed practical recommendations for increasing physical activity among persons living with HIV. AIDS. 2019 May 1;33(6):931-939. doi: 10.1097/QAD.0000000000002137. PMID: 30946147
  • Kietrys D, Myezwa H, Galantino ML, Parrott JS, Davis T, Levin T, O’Brien K, Hanass-Hancock J. Functional Limitations and Disability in Persons Living with HIV in South Africa and United States: Similarities and Differences. J Int Assoc Provid AIDS Care. 2019 Jan-Dec;18:2325958219850558. doi: 10.1177/2325958219850558. PMID: 31109225

1 CIHR Canadian HIV Trials Network. HIV, Aging and the CTN.

2 McMillan JM, Rubin LH, Gill MJ. HIV diagnosed after 50 years of age. CMAJ. 2020 Mar 9;192(10):E255. doi: 10.1503/cmaj.191677. PMID: 32152053

3 Montoya JL, Jankowski CM, O’Brien KK, Webel AR, Oursler KK, Henry BL, Moore DJ, Erlandson KM. Evidence-informed practical recommendations for increasing physical activity among persons living with HIV. AIDS. 2019 May 1;33(6):931-939. doi: 10.1097/QAD.0000000000002137. PMID: 30946147

4 O’Brien KK, Brown DA, Corbett C, Flanagan N, Solomon P, Vera JH, Aubry R, Harding R. AIDSImpact special issue – broadening the lens: recommendations from rehabilitation in chronic disease to advance healthy ageing with HIV. AIDS Care. 2020 May;32(sup2):65-73. doi: 10.1080/09540121.2020.1739203. Epub 2020 Mar 24. PMID: 32208741.

5 Galantino ML, Kietrys D. Aging gracefully with HIV disease: Optimizing wellness through models of care. Rehabilitation Oncology 2019:37;3-4.

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