Pharmacological Management of Comorbidities in Patients with HIV/AIDS: Implications for the Physical Therapist

Purpose: The purpose of this study is to inform physical therapists of the medications that patients with HIV or AIDS may be taking in addition to antiretroviral treatment (ART) to control comorbidities, discuss the implications for physical therapy treatment, and help guide clinical decision making when working with this patient population. Subjects: Patients in this study were primarily male (73%; n = 555) with 25% (n = 193) female and 2% (n = 17) transgender. The average age was 46.9 ± 12.1 years. Methods and Materials: Secondary analysis of a completed North Texas Regional Institutional Review Board approved demonstration project dataset examining medication therapy management in 765 patients aged ≥ 18 years diagnosed with HIV or AIDS. Patients’ medications were analyzed for those that could alter blood pressure, blood sugar, pain perception, and mentation. Analyses: Descriptive analysis of data was performed. Results: Of the 765 patients, 692 (90%) patients were taking an average of five medications for management of comorbidities. There were 294 (38%) patients taking at least one antihypertensive agents. ACE inhibitors (27%) and beta blockers (21%) comprised nearly half of the antihypertensive medications. There were 79 (10.3%) patients taking at least one antidiabetic medication. A total of 328 (43%) patients were taking at least one medication for management of a psychological condition. Antidepressants (57%) and anxiolytics (23%) comprised the majority of antipsychotics. There were 329 (43%) patients taking at least one medication for pain management. Non-steroidal anti-inflammatory drugs (48%) and opioid analgesics (32%) comprised the majority of the pain medications. There were 128 (17%) patients taking an opioid for pain management. Of the four medication categories analyzed, 177 (23%) patients were taking a medication from two categories, 113 (15%) taking three, and 21 (3%) taking a medication from all four. Conclusions: Our data help to describe and quantify the complex medication regimens to which patients with HIV/AIDS may be adhering in order to manage their comorbidities. Physical therapists should be aware of the high rates of antihypertensive, psychoactive, and analgesic medication prescription in this patient population, perform thorough screenings of adverse effects, and provide physical therapy treatment that contributes to comorbidity management. It is also important to note the high rate of opioid use in this patient population, suggesting that treatments emphasizing pain management through modalities, gentle aerobic exercise, and education may be beneficial.