Practical Tips for Caring for HIV/AIDS Patients

A nurse practitioner who has been caring for HIV/AIDS patients for over15 years has some practical tips for dealing with the common symptoms associatedwith the disease. Dr. Gayle Newshan, PhD, NP, offered her advice duringa recent teleconference sponsored by Cancer Care, Inc, and the Gay Men'sHealth Crisis. Dr. Newshan, who practices at the AIDS Center at St. Vincent'sHospital in New York City, discussed the management of pain, fatigue, weightloss, itching and other symptoms with HIV/AIDS patients and caregivers.

The most common complaint of her patients is pain and if they learnto effectively describe their symptoms, proper treatment can be determined,she said. "HIV patients often get neuropathy pain, a burning withtingling or pins and needles in the feet that can travel up into the leg.They can also have pain on swallowing which can be from thrush or fromulcers. If it's a burning pain, oftentimes it's related to thrush. If it'sa very sharp pain, it's related to certain kinds of ulcers."

For neuropathy or joint pain, she recommends regular exercise. "Evensimple walking or stretching exercises can help decrease pain in the jointsand legs." Massage also allays pain effectively, she said and old-fashionedremedies, such as hot water bottles or heating pads, ice packs or coolwash cloths can bring some relief. Relaxation exercises and tapes, alongwith distractions such as talking on the phone or watching TV are goodtoo. And Dr. Newshan recommends laughter--"It increases their endorphins,"she notes.

Itching, another common symptom, can be caused by a minor problem orit could signal an allergy to medication or an HIV-related inflammationof the hair follicles. HIV folliculitis is generally treated with ultravioletlight, but if the itching is just the result of dryness, the skin shouldbe lubricated with moisturizing lotion or the addition of bath oil or bakingsoda to the bath water. Dr. Newshan warned against using Ivory soap ("Itis actually very drying") and recommended Dove or Basis instead. Shealso advised patients to keep their nails short to avoid scratching themselvesand causing infection.

Fatigue

Fatigue, another symptom, can often be alleviated by improving the diet(increasing proteins and decreasing sugars) once low thyroid or low testosteronehave been ruled out. Rest (though not spending all day in bed), avoidingalcohol and drugs, and pacing one's activities helps keep energy flowing.Dr. Newshan also suggests ginseng to boost energy and keep nausea undercontrol. Of course, depression can contribute to fatigue. If patients feelthey are depressed, they should be evaluated by a psychiatrist.

People who have trouble sleeping, Dr. Newshan says, "Need to avoidsleeping medications because those can actually disrupt the natural sleeprhythym." She recommends they reestablish a normal sleep pattern insteadby going to bed at a regular time and getting up at a regular time. Theymust also avoid eating an hour before bedtime and drinking alcoholic orcaffeinated drinks after 6pm.

Patients who are nauseous or vomit should have their medications reviewedby their physician. Then, in addition to taking anti-nausea medicationif prescribed, they should avoid hard to digest foods, raw fruits and vegetablesand anything cold or icy. They should also eat smaller, more frequent mealsand take medications in an upright position, half an hour before eating.

If diarrhea is a problem, the rectum often becomes irritated. Zinc ointmentcan be applied around the rectum. Dr. Newshan also advised that patientsdrink salty fluids such as broths and sports drinks and eat binding foods.Taking Metamucil will help to bulk up the stool. Dr. Newshan has had successgiving Motrin three or four times a day to patients with HIV colitis whohave diarrhea. The non-steroidal may work because colitis seems to havean inflammatory component, she said.

Fever

Patients prone to fevers need to track their fevers and contact theirdoctor if their fever goes over 101. They should go to an emergency roomif the fever rises to 103 and over, said Dr. Newshan. Fevers are treatedwith plenty of fluids. Patients should also wrap themselves with blanketstaking special care to cover their extremities including their heads. Alcoholrubs and tepid baths could produce shivering and actually raise the bodytemperature.

Weight Loss

For weight loss in HIV patients, one approach that works is to ask thepatients why they think they are losing weight. The reason could be assimple as lack of money or it could stem from a medical condition. Patientsshould increase their caloric intake, use food supplements like Ensureand eat smaller, more frequent meals. Megace and Marinol also may help,Dr. Newshan said. In addition, testosterone can have a positive affecton weight loss, and on lack of energy or depression. But, "patientscan get a little aggressive" after taking testosterone and "ifthat's the case, the normal dose of 200 to 300 mg every other week shouldbe reduced," she advised.

For many people, however, weight loss is caused by the HIV virus itself.Patients who are on anti-retroviral combination therapies often noticethat as their viral load decreases, they gain their weight back.