Introduction.
Infection by the human immunodeficiency virus (HIV) is lifelong leading eventually, in the great majority of patients, to a severe deficiency of the immune system. This leads to vulnerability to a range of serious infections (including various types of pneumonia and meningitis) and certain tumours (including some which are rare in other people eg. Kaposi's sarcoma of the skin) which eventually cause death. In addition HIV infection can be associated with a range of other physical and psychological complications. Infection is at present mainly among male homosexuals, intravenous drug abusers and the partners of affected individuals. There are a number of people who were infected by contaminated blood products before the danger was recognised. Many of these (eg. haemophiliacs) may have other health problems. Babies born to affected women may have the infection as a congenital condition.
General.
Early classifications of HIV infection used a variety of terms such as AIDS related complex and complicated AIDS. There is a move away from this and people should be described according to their own individual set of circumstances.
People progress at different rates from being asymptomatic (HIV positive) to having AIDS. It has been estimated that 50% will progress to having AIDS within 10 years & 65% within 14 years. New anti-retroviral drugs can substantially delay or temporarily reverse the progression of the disease in most people if given before irreversible damage to the immune system has occurred. However, eventual progress is likely. Once immune deficiency disease is established, the course is episodic, with episodes of severe infection being separated by periods of reasonable health. There will however be a steady progression with people being more and more disabled by the effects of previous infections or tumours. In addition the HIV itself may cause encephalopathy, and a number of other psychological or physical complications.
General symptoms due to HIV infection include fatigue and general psychological debility. Some patients may experience severe night sweats which require a change of clothing or bedding. Gastro-intestinal disease may lead to severe diarrhoea and weight loss. Patients may develop a variety of neurological complications which include encephalopathy leading to failure of short term memory, dementia, depression or hypomania. Involvement of the spinal cord or peripheral nerves can lead to progressive muscle weakness.
In some patients the results of laboratory tests may be available eg the CD4 lymphocyte count and the HIV viral load. These are useful measures of the current disease state and predictors of prognosis. However, they should only be interpreted in the light of the overall condition of the person. In general, advice from a Medical Services doctor will be required in order to assess their significance.
Care Needs.
Many patients with HIV infection have a prolonged period when they are well (asymptomatic HIV infection). As the disease progresses the affected individual, though able to perform the majority of bodily functions when taken in isolation, cannot maintain the effort and is unable to get through the day without help from another person.
With the increasing burden of HIV disease, affected individuals are likely to need increasing amounts of attention during the day. If sweats and other symptoms occur at night, there is likely to be a need for attention at night as well. People who develop dementia and related neurological defects may expose themselves to common dangers within the home and consequently may require supervision by day and watching over by night. One effect of late disease is cytomegalovirus retinitis which can cause progressive loss of sight leading to significant visual impairment or blindness. This will need to be taken into account in the determination of the overall care needs.
Mobility Considerations.
As the disease progresses, the person is likely to have difficulty with walking as a result of the overall poor general state of health. Those with neurological disorders causing muscle weakness, or those with severe breathlessness are likely to have particular difficulties. If dementia or significant visual impairment develops, a need for guidance or supervision when walking may be present.
Duration of Need.
Despite the occurrence of periods of relatively good health, the effects of HIV infection are usually progressive. Consequently, care and mobility needs are likely to increase with time.
Further Evidence.
A factual report on the affected person's clinical condition should be obtained, preferably from their specialist physician, but alternatively from the general practitioner. In many cases, a large amount of potentially complex information may be present. Advice from a Departmental doctor will help in the interpretation of this information and enable it to be related to the care and mobility needs of the individual.
