HIV-1 ile Yaşayan Bireylerde İstemli Motor Kontrol ve Statik dengenin Değerlendirilmesi

Abstract

According to the World Health Organization, 39.9 million people worldwide are living with HIV. The development of antiretroviral therapies has increased the lifespan of these individuals; however, this increase has also led to a higher prevalence of comorbidities such as osteoporosis, cardiovascular disease, and hypertension. These comorbidities can adversely affect the physical functionality and quality of life of individuals living with HIV. This study aims to evaluate balance and voluntary motor control in individuals living with HIV (PLWH) and to investigate the clinical factors influencing these conditions.

During the study, 167 individuals diagnosed with HIV-1 infection were assessed, but 10 individuals who lacked sufficient balance function to maintain an upright position on the platform were excluded. As a result, 157 individuals were included in the study. Each participant underwent assessment using the Limits of Stability (LoS) and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Objective balance evaluations were performed using mCTSIB, and participants' composite scores were compared with normative values for their age and gender. Based on this assessment, participants were categorized into two groups: those with normal balance and those with balance disorders.

Among individuals with balance disorders, longer durations of HIV diagnosis were noteworthy. After controlling for age and associated comorbidities, individuals with a diagnosis duration of 10 years or more had approximately 5.4 times higher risk of balance disorder compared to other groups (OR: 5.399, 95% CI: 1.312-22.228, p=0.020). Furthermore, the fracture risk assessed by FRAX in the balance disorder group was significantly higher compared to those with normal balance; the risk of hip fracture was 21.2% in the balance disorder group versus 4.0% in the normal group. Similarly, the major osteoporotic fracture risk was 18.2% in the balance disorder group and 1.6% in the normal group (p=0.004 and p=0.001). According to the SF-36 survey results, scores for physical function (median: 80 vs. 95, p<0.001), social functioning (median: 75 vs. 87.75, p=0.039), pain (median: 73.75 vs. 100, p=0.006), and general health perception (median: 55 vs. 65.50, p=0.041) were significantly lower in the balance disorder group compared to the normal balance group.

Our findings indicate that individuals living with HIV who have balance disorders face serious health challenges due to increased risks of falls and fractures. The rise in hip and major osteoporotic fracture risks highlights the elevated morbidity and mortality risks in this group. This underscores the necessity for vigilant monitoring and proactive interventions in health management to maintain the physical integrity of these individuals. The SF-36 survey results show that individuals with balance disorders have lower social functioning, physical function, and general health perception, suggesting difficulties in maintaining functional capacity and participating in social life. It is crucial to develop multidisciplinary approaches and personalized treatment plans to improve the quality of life for individuals living with HIV. Implementing balance training and preventive strategies to reduce fracture risk can enhance their independence in daily activities and promote active social participation, thereby potentially reducing morbidity and mortality and significantly improving overall health and quality of life.