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UKZN Academic Writes Chapter of New Book on Improved Health Ideas for HIV and AIDS Sufferers

June 25, 2015

 Dr Sonill Maharaj.
The first chapter of a new book collaboratively written by international experts to help improve the lives of HIV and AIDS patients receiving antiretroviral drugs (ARVs), was authored by the UKZN Academic Leader for Physiotherapy, Dr Sonill Maharaj. 

The book titled: "Health of HIV Infected People: Food, Nutrition and Lifestyle with Antiretroviral Drugs", helps health professionals to develop an understanding of nutritional dysfunction in antiretroviral treated HIV and AIDS patients, providing a pathway for improved health using food, dietary supplements, and nutrients. 

With a keen interest in sport and HIV related rehabilitation, Maharaj contributed the opening chapter on exercise and rehabilitation under the title: "Exercise in the Era of HAART in South Africa."

In this chapter, Maharaj reflects on the use of highly active antiretroviral therapy (HAART) by infected individuals in the country over the past decade. He acknowledges that HAART – which is a triple combination of ARVs – has changed the prognosis of AIDS from a terminal to chronic cyclical illness ‘because the combination of drugs results in elevating the CD4 counts in infected individuals and increasing the potential to live longer’. 

Maharaj said it was estimated that more than 80 percent of individuals diagnosed with AIDS and receiving HAART survive for three years or more with a lower incidence of opportunistic infections. ‘It is reported that these infected individuals are presenting with an increase in chronic health problems, impairments, and disabilities compared with the pre- HAART era,’ Maharaj warned. 

‘Projections in South Africa indicate that beyond 2015, the number of patients with chronic AIDS will continue to increase even with treatment. The reason for this is that HIV infection and HIV drug therapies cause physical and psychological challenges for the patients. The physical challenges result from neuro-musculo-skeletal symptoms with neurologic manifestations. Of these, peripheral neuropathy seems to be the most common condition, followed by respiratory complications, mainly pneumonia and tuberculosis.’ 

Maharaj explained that the neurologic complications may be related to studies that have documented relationships among the central or peripheral nervous system, peripheral neuropathy, and the HIV infection, in association with antiretroviral therapy. 

‘The effects of these conditions may lead to the affected person spending less time on vigorous activities because of the lower aerobic capacity and functional limitations and this can be attributed to a detraining effect and the resultant poor quality of life.’ 

Since the incidence and prevalence rates of HIV and AIDS are still on the increase, says Maharaj, the South African health services are challenged by the double impact of an increase in HIV-related illnesses and TB, while financial and human resources available to meet these challenges, mainly in public hospitals, are limited.

 Maharaj said alternative therapies were warranted and necessary so that the infected individuals could have options in terms of potential treatment outcomes, and maintaining and improving their quality of life while motivating them to adhere to and comply with HAART, ‘thus maintaining CD4 cell counts of greater than 200 cells/mm³, critical for therapeutic success in the treatment of HIV infection’. 

Maharaj lobbied for patient-based outcomes and improvement in quality of life as the main objectives of treatment. He said generally, exercises were known to improve immune function and quality of life for the individuals with HIV by improving their lung function, breathing, and ventilation and their physical and emotional status and by delaying AIDS-related complications. 

He presented research findings which highlighted that since rehabilitation management and techniques required self-activity to ensure physical and mental health, one of the primary methods to facilitate this was through the engagement of these individuals to participate in exercise programmes.

 Maharaj advised that exercises, in particular rebound exercise, seemed to have beneficial outcomes in infected individuals and should therefore be encouraged. ‘However, any exercise programme must be used with appropriate caution in this population.’

Lunga Memela

Uploaded by: Fhumulani Andrew Liabara

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