OTHER IMMUNE CONDTIONSOTHER IMMUNE CONDTIONS

• HIV and AIDS

• LUPUS

• FIBROMYALGIA

• HIV and AIDS

• LUPUS

• FIBROMYALGIA

HUMAN IMMUNODEFICIENCY

VIRUSand

AQUIRED IMMUNODEFICIENCY

SYNDROME

HUMAN IMMUNODEFICIENCY

VIRUSand

AQUIRED IMMUNODEFICIENCY

SYNDROME

AIDSAIDS1. Immunodeficiency

disorder caused by a virus that destroys T-Cells.

2. The HIV Virus is harbored in the macrophage and Helper T-Cells.

3. The DNA of the virus directs the cells to create new viruses.

1. Immunodeficiency disorder caused by a virus that destroys T-Cells.

2. The HIV Virus is harbored in the macrophage and Helper T-Cells.

3. The DNA of the virus directs the cells to create new viruses.

CELLS OF THE IMMUNE SYSTEM

CELLS OF THE IMMUNE SYSTEM

Leukocytes

Granulocytes Monocytes Lymphocytes

Neutrophil Eosinophil Basophil T-CELL B-CELL LGL/NK

HELPER & INFLAMMATORY

CYTOTOXIC T

CELLS OF THE IMMUNE SYSTEM

CELLS OF THE IMMUNE SYSTEM

Leukocytes

Granulocytes Monocytes Lymphocytes

Neutrophil Eosinophil Basophil T-CELL B-CELL LGL/NK

HELPER & INFLAMMATORY

CYTOTOXIC T

ADAPTIVE IMMUNITYADAPTIVE IMMUNITY

• Cytotoxic T-Cells

• Specific Antigens

• Natural Killer Cells

• Any Antigen

• Cytotoxic T-Cells

• Specific Antigens

• Natural Killer Cells

• Any Antigen

• Kills on Contact

• Releasing Granules

• Kills on Contact

• Releasing Granules

INFECTION• Bad Flu-like

• Several weeks

INFECTION• Bad Flu-like

• Several weeks

ASYMPTOMATIC

• 10 YRS

ASYMPTOMATIC

• 10 YRS

CLINICAL

AIDS• Infection of an

opportunistic organism, not normally infectious

CLINICAL

AIDS• Infection of an

opportunistic organism, not normally infectious

EXERCISE CONCERNS in HIV and AIDS

EXERCISE CONCERNS in HIV and AIDS

• DECONDITIONING

• MUSCLE WASTING

• LIPODYSTROPHY

• DECONDITIONING

• MUSCLE WASTING

• LIPODYSTROPHY

DECONDITIONINGDECONDITIONING

Deleterious effects of bed restDeleterious effects of bed rest• Cardiovascular • Skeletal muscle• Bone and calcium metabolism

• Cardiovascular • Skeletal muscle• Bone and calcium metabolism

• Metabolic and endocrine • Psychosocial

• Metabolic and endocrine • Psychosocial

WASTINGWASTING

• 5% Loss in Body Weight increases Mortality

• Loss is directly related to lack of modern AIDS treatment

• 5% Loss in Body Weight increases Mortality

• Loss is directly related to lack of modern AIDS treatment

• Decreased Strength

• Decreased Muscle Mass

• Decreased Strength

• Decreased Muscle Mass

LIPODYSTROPHYLIPODYSTROPHY

• Loss of subcutaneous fat

• Arms• Legs• Face

• Increase in visceral abdominal fat

• Loss of subcutaneous fat

• Arms• Legs• Face

• Increase in visceral abdominal fat

Fat Redistribution SyndromeFat Redistribution Syndrome

LIPODYSTROPHYLIPODYSTROPHY

• Insulin Resistance

• Elevated Glucose

• Decreased HDL

• Upper Body Obesity• Cardiovascular Disease• Stroke• Diabetes

• Insulin Resistance

• Elevated Glucose

• Decreased HDL

• Upper Body Obesity• Cardiovascular Disease• Stroke• Diabetes

EXERCISE EFFECTIVENESSEXERCISE EFFECTIVENESS

• Improve Physical Work Capacity

• Improve Mood

• Improve Immune Function

• Decrease Chronic Disease Incidence

• Increase Muscle Strength

• Increase Muscle Mass

• Improve Physical Work Capacity

• Improve Mood

• Improve Immune Function

• Decrease Chronic Disease Incidence

• Increase Muscle Strength

• Increase Muscle Mass

Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

CONTROL• Maintain current level of activity

CONTROL• Maintain current level of activity

MODERATE INTENSITY• 60 min

• 3/wk

• 80% of Lactate Threshold

MODERATE INTENSITY• 60 min

• 3/wk

• 80% of Lactate Threshold

HEAVY INTENSITY• 3/wk

• 30-40 min

• 50% of VO2max – Lactate Threshold

HEAVY INTENSITY• 3/wk

• 30-40 min

• 50% of VO2max – Lactate Threshold

Cycle Ergometry

Total Amount of Work

Moderate = Heavy

6 weeks

Cycle Ergometry

Total Amount of Work

Moderate = Heavy

6 weeks

Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

0

100

200

300

400

500

600

Control Moderate Heavy

Pre

Post

SKIN REACTIVITY TESTSA

rea

(m

m2)

Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

0

10000

20000

30000

40000

50000

60000

Control Moderate Heavy

Pre

Post

HIV VIRAL REPLICATIONC

op

ies

/mL

Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

QUALITY OF LIFEQUALITY OF LIFE1. How would you rate the quality of your life now?

2. How much longer do you want to live

3. How much longer do you think you will live?

4. Compared to one year ago, how much does your health limit your daily activities? (1=none; 5 = Very limited)

5. I look forward to the future with hope. (1=agree; 5 = disagree)

6. Overall, how would your rate your quality of life? (0=worst; 10 = best).

7. Which best describes how your feel about our life as a whole? (1=terrible; 7=delighted)

1. How would you rate the quality of your life now?

2. How much longer do you want to live

3. How much longer do you think you will live?

4. Compared to one year ago, how much does your health limit your daily activities? (1=none; 5 = Very limited)

5. I look forward to the future with hope. (1=agree; 5 = disagree)

6. Overall, how would your rate your quality of life? (0=worst; 10 = best).

7. Which best describes how your feel about our life as a whole? (1=terrible; 7=delighted)

Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998.

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

1 2 3 4 5 6 7

Control

Moderate

Heavy

QUALITY OF LIFEQUALITY OF LIFE

NS

Cha

nge

in S

core

OTHER INTERVENTION STUDIES

• CD4 COUNTS INCREASED IN THOSE pts WHO ADHERED

• CD4 COUNTS INCREASED IN THOSE pts WHO ADHERED

MacArthur, RD et al Med Sci Sports Exerc 25:684-688, 1993

PHARAMCOLOGYPHARAMCOLOGYHIGHLY ACTIVE ANTIRETROVIRAL THERAPY

HAART

HIGHLY ACTIVE ANTIRETROVIRAL THERAPY

HAART

• 2-5 Meds

• 1-4 doses/day

• Eating & Drinking restrictions with 1-2 hrs of taking meds

• 2-5 Meds

• 1-4 doses/day

• Eating & Drinking restrictions with 1-2 hrs of taking meds

• Nucleoside Reverse-Transcriptase Inhibitors (NRTI)

• Nonnucleoside Reverse-Trancriptase Inhibitors (NNRTI)

• Protease Inhibitors

• Nucleoside Reverse-Transcriptase Inhibitors (NRTI)

• Nonnucleoside Reverse-Trancriptase Inhibitors (NNRTI)

• Protease Inhibitors

PHARAMCOLOGYPHARAMCOLOGY

ANABOLIC STERIODSANABOLIC STERIODS

• Nandrolone decanoate

• Oxandrolone

0

1

2

3

4

5

6

7

ND OX

Control

Exercise

Incr

ea

se in

Le

an

Mas

s (k

g)

EXERCISE TESTINGEXERCISE TESTING

• BODY COMPOSITION• Lean Body Mass• Body Fat Distribution• Skinfold thickness at each site

• FUNCTIONAL ASSESSMENT• Cardiovascular Endurance

• 6 min walk• Stress Testing

• Muscle Strength• Flexibility

• BODY COMPOSITION• Lean Body Mass• Body Fat Distribution• Skinfold thickness at each site

• FUNCTIONAL ASSESSMENT• Cardiovascular Endurance

• 6 min walk• Stress Testing

• Muscle Strength• Flexibility

EXERCISE PRESCRIPTIONEXERCISE PRESCRIPTION

GOALS:

1. Improve Physical Work Capacity

2. Increase Muscle Mass

3. Increase Muscle Strength

4. Counteract lipodystrophy

5. Improve Immune Function

GOALS:

1. Improve Physical Work Capacity

2. Increase Muscle Mass

3. Increase Muscle Strength

4. Counteract lipodystrophy

5. Improve Immune Function

EXERCISE PRESCRIPTIONEXERCISE PRESCRIPTION

ENDURANCE STRENGTH

MODE CV Resistance

FREQUENCY 3/wk 3/wk

DURATION 15-25 min 45 min

INTENSITY 65-85% 60-80% RM

ENDURANCE STRENGTH

MODE CV Resistance

FREQUENCY 3/wk 3/wk

DURATION 15-25 min 45 min

INTENSITY 65-85% 60-80% RM

• Intercurrent Illness• Decrease Intensity• Discontinue

• Fever >100o

• Acute Symptoms• Nausea• Vomiting• Uncontrolled Diarrhea• Dehydration

• Injury (wasting)

• Intercurrent Illness• Decrease Intensity• Discontinue

• Fever >100o

• Acute Symptoms• Nausea• Vomiting• Uncontrolled Diarrhea• Dehydration

• Injury (wasting)

PRECAUTIONSPRECAUTIONS

LUPUSLUPUS

LUPUS ERYTHEMATOSUS

• Chronic Autoimmune Disease

• Produces Antibodies to Fight own Tissues

LUPUS ERYTHEMATOSUS

• Chronic Autoimmune Disease

• Produces Antibodies to Fight own Tissues

INCIDENCE:• 1.4 – 1.5 Million

• 16,000 / year

• 90% Women

• 15-45 years old

• 2-3x in Minorities

INCIDENCE:• 1.4 – 1.5 Million

• 16,000 / year

• 90% Women

• 15-45 years old

• 2-3x in Minorities

TYPES OF LUPUSTYPES OF LUPUSDISCOID• Affects the Skin

• Rash• Abnormal Skin Biopsy

• Can evolve to Systemic in 10% of cases

DISCOID• Affects the Skin

• Rash• Abnormal Skin Biopsy

• Can evolve to Systemic in 10% of cases

SYSTEMIC

• Any Organ of the Body

• Predominantly Skin & Joints

• Heart, Lungs, Kidneys, Blood

SYSTEMIC

• Any Organ of the Body

• Predominantly Skin & Joints

• Heart, Lungs, Kidneys, Blood

DRUG-INDUCED• Only 4% who take

• Hydralazine

• Procainamide

DRUG-INDUCED• Only 4% who take

• Hydralazine

• Procainamide

Sx:• Arthraligia (achy joints) 95%• Fever >100o 90%• Arthritis (swollen joints) 90%• Prolonged or Extreme Fatigue 81%• Skin Rashes 74%• Anemia 71%• Kidney Involvement 50%• Butterfly Rash on cheeks/nose 42%• Sun or Light Sensitivity 30%• Abnormal blood clotting 20%• Raynaud’s Phenomenon 17%• Seizures 15%• Mouth or Nose Ulcers 12%

Sx:• Arthraligia (achy joints) 95%• Fever >100o 90%• Arthritis (swollen joints) 90%• Prolonged or Extreme Fatigue 81%• Skin Rashes 74%• Anemia 71%• Kidney Involvement 50%• Butterfly Rash on cheeks/nose 42%• Sun or Light Sensitivity 30%• Abnormal blood clotting 20%• Raynaud’s Phenomenon 17%• Seizures 15%• Mouth or Nose Ulcers 12%

• Susceptible Genes

• Environmental Factors• Infectious Agents• Meds

• Anticonvulsants

• Penicillins• Estrogen Therapy

• Excessive Ultraviolet Light• Physical Trauma• Emotional Stress

• Susceptible Genes

• Environmental Factors• Infectious Agents• Meds

• Anticonvulsants

• Penicillins• Estrogen Therapy

• Excessive Ultraviolet Light• Physical Trauma• Emotional Stress

ETIOLOGY

DIAGNOSIS• Medical History• Physical Examination• Blood Tests

DIAGNOSIS• Medical History• Physical Examination• Blood Tests

RHEUMATOLOGIST must rule out• Chronic Fatigue Syndrome

• Mononucleosis

RHEUMATOLOGIST must rule out• Chronic Fatigue Syndrome

• Mononucleosis

POSITIVE:• Butterfly Rash

• Sun Sensitivity

• Kidney Disorder

• Blood Abnormalities

• +4/11 other criteria

POSITIVE:• Butterfly Rash

• Sun Sensitivity

• Kidney Disorder

• Blood Abnormalities

• +4/11 other criteria

THE ELEVEN CRITERIA• Malar Rash Cheeks

• Discoid Rash Red Raised Patches

• Photosensitivity

• Oral Ulcers Nose or mouth

• Arthritis Nonerosive >2 peripheral joints

• Serositis Inflamation of lining of lung or heart

• Renal Disorder Excessive protein in urine

• Neurologic Disorder Seizures and/or psychosis

THE ELEVEN CRITERIA• Malar Rash Cheeks

• Discoid Rash Red Raised Patches

• Photosensitivity

• Oral Ulcers Nose or mouth

• Arthritis Nonerosive >2 peripheral joints

• Serositis Inflamation of lining of lung or heart

• Renal Disorder Excessive protein in urine

• Neurologic Disorder Seizures and/or psychosis

• Hematologic Disorder Anemia or Leukopenia or lymphopenia or thrombocytopenia

• Antinuclear Antibody + antibodies

• Immunologic Disorder + anti-DNA test + anti-SM test false +syphilis test + antiphospholipid antibody

• Hematologic Disorder Anemia or Leukopenia or lymphopenia or thrombocytopenia

• Antinuclear Antibody + antibodies

• Immunologic Disorder + anti-DNA test + anti-SM test false +syphilis test + antiphospholipid antibody

TREATMENT• Medications

• Aspirin

• Non-Steroidal Anti-Inflammatory (NSAIDs)

• Acetaminophen (tylenol)

• Antimalarials

• Corticosteroids

• Anticoalgulants

• Avoid Sunlight

• Eat Healthy Diet• Exercise• Minimize Stress• Bone Marrow Transplant (experimental)

TREATMENT• Medications

• Aspirin

• Non-Steroidal Anti-Inflammatory (NSAIDs)

• Acetaminophen (tylenol)

• Antimalarials

• Corticosteroids

• Anticoalgulants

• Avoid Sunlight

• Eat Healthy Diet• Exercise• Minimize Stress• Bone Marrow Transplant (experimental)

FIBROMYALGIAFIBROMYALGIA• Pain in Muscles and Joints

• Poor Sleep

• Headaches

• Stiffness

• Muscle Aches

• Sensitivity to

• Bright Light• Loud Noise• Meds

• Fatigue

• Pain in Muscles and Joints

• Poor Sleep

• Headaches

• Stiffness

• Muscle Aches

• Sensitivity to

• Bright Light• Loud Noise• Meds

• Fatigue

• 5% of Population

• More common in Women

• Women of Child Bearing Ages

• 5% of Population

• More common in Women

• Women of Child Bearing Ages

Mostly a

ssocia

ted

with R

heumatic

Disease

s

Mostly a

ssocia

ted

with R

heumatic

Disease

s

CLINICAL FEATURESCLINICAL FEATURES

• 90-100%

• Generalized Pain

• Fatigue

• Stiffness

• Morning Fatigue

• 90-100%

• Generalized Pain

• Fatigue

• Stiffness

• Morning Fatigue

• 70-90%• Post-exertional malaise• Sleep disturbances• Morning stiffness• Headaches• Tenderness• Swollen Feeling in tissues• Numbness & tingling• Cognitive Impairment• Dizziness• Sensitivity to Noise• Sensitivity to Smell & Stress• Menstrual cramping• Dry mouth

• 70-90%• Post-exertional malaise• Sleep disturbances• Morning stiffness• Headaches• Tenderness• Swollen Feeling in tissues• Numbness & tingling• Cognitive Impairment• Dizziness• Sensitivity to Noise• Sensitivity to Smell & Stress• Menstrual cramping• Dry mouth

• 50-70%

• Irritable bowel syndrome

• Blurred Vision

• Mood Swings

• Heart Palpatations

• Cold Extremities

• Feverous feeling

• Allergies

• 50-70%

• Irritable bowel syndrome

• Blurred Vision

• Mood Swings

• Heart Palpatations

• Cold Extremities

• Feverous feeling

• Allergies

• 15-50%

• Restless legs

• Muscle twitches

• Itchy skin

• Hearing disturbances

• Night sweats

• Migraines

• Breathing problems

• Skin rashes

• TMJ dysfunction

• Chemical sensitivities

• 15-50%

• Restless legs

• Muscle twitches

• Itchy skin

• Hearing disturbances

• Night sweats

• Migraines

• Breathing problems

• Skin rashes

• TMJ dysfunction

• Chemical sensitivities

• Below 15%

• Major depression

• Below 15%

• Major depression

CLINICAL FEATURESCLINICAL FEATURES

DIAGNOSISDIAGNOSIS

11/18 + POINTS11/18 + POINTS

TREATMENTTREATMENT

• Medications• Sleep Meds• Seritonin• NSIADs

• Exercise

• Relaxation Techniques

• Educational Programs

• Diet

• Medications• Sleep Meds• Seritonin• NSIADs

• Exercise

• Relaxation Techniques

• Educational Programs

• Diet

EXERCISEEXERCISE

MODE Walking, Jogging, Cycling

Swimming, Flexibility, ROM

FREQUENCY 4/wk

DURATION up to 60 min

INTENSITY Moderate

MODE Walking, Jogging, Cycling

Swimming, Flexibility, ROM

FREQUENCY 4/wk

DURATION up to 60 min

INTENSITY Moderate

Exercise in the afternoon or early eveningExercise in the afternoon or early evening