HIV/AIDS

Pathophysiology

Reverse transcriptase mechanism: HIV uses reverse transcriptase to convert its RNA into DNA, which integrates into the host CD4+ T cell genome. Rapid viral replication ruptures CD4 cells or triggers apoptosis
Four phases:
Phase 1 (Incubation): No symptoms or detectable antibodies; "window period" up to 6 months
Phase 2 (Acute Primary): Flu-like symptoms 1-4 weeks after exposure; seroconversion
Phase 3 (Latency): Asymptomatic for 10+ years with modern treatment; CD4 counts gradually fall
Phase 4 (Overt AIDS): CD4 below 200; opportunistic infections appear (Pneumocystis pneumonia, toxoplasmosis, candidiasis, CMV retinitis)
Lipodystrophy: Antiretroviral medications cause fat redistribution — fat loss in cheeks and buttocks, accumulation in upper back ("buffalo hump") and abdomen
Neurological involvement: HIV crosses the blood-brain barrier causing AIDS dementia complex (cognitive decline, motor impairment)
Hypercoagulability: HIV independently increases thrombotic risk. DVT screening is important

Unexplained weight loss, drenching night sweats, persistent fatigue
Kaposi's sarcoma (brown/purple skin lesions), persistent rashes, oral thrush
Lipodystrophy from medications (visible fat redistribution)
Persistent generalized lymphadenopathy (swelling in 2 or more extra-inguinal sites for >3 months)
Peripheral neuropathy (numbness, burning in glove-and-stocking distribution)

New-onset Kaposi's sarcoma lesions or oral candidiasis in a previously stable client — may indicate treatment failure or immune decline. Refer to physician
DVT signs (unilateral leg swelling, warmth, pain) — HIV increases thrombotic risk. Apply Wells criteria
Sudden cognitive decline or motor impairment — may indicate AIDS dementia complex or CNS opportunistic infection. Urgent medical referral
Pneumocystis pneumonia (progressive dyspnea, dry cough, fever) — most common AIDS-defining illness. Requires immediate treatment

Massage is safe and cannot transmit HIV; the primary risk flows in the opposite direction — the therapist carrying pathogens to the immunocompromised client
Kaposi's sarcoma: Local contraindication over open lesions or active skin infections. Work around them with standard precautions
Therapist precautions: If the therapist has broken skin, use a finger cot or liquid bandage. Standard universal precautions apply
Late-stage AIDS: Patients may be frail with hypersensitive skin. Sessions should be shorter, gentler, and flexible. Monitor for fatigue during treatment
Peripheral neuropathy: Glove-and-stocking numbness prohibits deep tissue work in affected areas. Assess sensation before treating distal extremities
Psychological benefit: Massage consistently reduces stress, anxiety, and depression — factors that further suppress immunity. Touch therapy addresses the isolation many HIV/AIDS patients experience
DVT screening: HIV-associated hypercoagulability increases thrombotic risk. Screen before lower extremity work

Know the four phases of HIV infection and their timeline
Massage cannot transmit HIV. The primary risk is therapist carrying pathogens to the immunocompromised client
Recognize opportunistic indicator diseases (Pneumocystis, toxoplasmosis, candidiasis, Kaposi's sarcoma)
Window period of up to 6 months post-exposure
HIV crosses the blood-brain barrier causing AIDS dementia complex

Massage cannot transmit HIV. The primary risk is the therapist carrying pathogens to the immunocompromised client.
Local massage is contraindicated over open Kaposi's sarcoma lesions or active skin infections.
Peripheral neuropathy (glove-and-stocking numbness) prohibits deep tissue work in affected areas.
Late-stage AIDS patients may be frail with hypersensitive skin. Sessions should be shorter, gentler, and flexible.
HIV increases thrombotic risk independently. Screen for DVT before lower extremity work.
If the therapist has broken skin, use a finger cot or liquid bandage to maintain universal precautions.