Functional aerobic impairment detected in HIV-seropositive teens

The ability to perform even low levels of physical activity is impaired in HIV-infected adolescents with no comorbid conditions, researchers in Baltimore have found. Dr. Randall E. Keyser, and associates from the University of Maryland School of Medicine, report that HIV fatigue-mediated disability can be detected using treadmill exercise testing and expired gas analysis. The subjects included 17 HIV-infected adolescents with a mean CD4+ count of 499 cells per microliter and no history of opportunistic infections. Peak exercise testing with spirometric measurements of oxygen uptake were performed, the results of which appear in the November issue of the Archives of Physical Medicine and Rehabilitation.

Mean peak oxygen consumption was 42% lower than expected for individuals their age, based on population-referenced computations. The investigators observed that five subjects had mild functional aerobic impairment, seven had moderate impairment, and two had extreme functional aerobic impairment. They attribute the cardiorespiratory insufficiency to myopathic involvement that can be observed during all stages of HIV infection, and may be caused by the infection itself, T-cell-mediated cytotoxicity or antiretroviral therapy.

Dr. Keyser’s group recommends that similar physiologic testing be conducted to quantify HIV-related impairment. Such objective evidence can be used to make accommodations for HIV-infected patients with disability associated with excessive fatigue.