103 THE ATHLETE WITH HIV
Robert J Dimeff, MD
Andrew M BlecherEPIDEMIOLOGY
WORLDWIDE
- According to the centers for disease control(CDC),
there were 42 million people with human immunode-
ficiency virus (HIV)/acquired immunodeficiency
(AIDS) through December 2002. - Last year there were 5 million new cases of
HIV/AIDS and 3.1 million AIDS deaths.
THE UNITED STATES
- According to the CDC there were 816,149 HIV/AIDS
patients in the United States through December 2001.
IN ATHLETES
- The incidence and prevalence of HIV/AIDS in ath-
letes is unknown, but there are several high profile
elite and professional athletes who have acquired
HIV including Earvin “Magic” Johnson in 1991
(competed in NBA and 1992 Summer Olympics with
HIV), Greg Louganis (competed in 1988 Olympics
with HIV), and Tommy Morrison (professional
boxing). - In addition, several professional athletes have died
from AIDS, including Jerry Smith (National Football
League or NFL), Alan Wiggins (Major League
Baseball), Esteban DeJesus (boxing), Tim Richmond
(stock car driver), Robert McCall (figure skating), and
Arthur Ashe (professional tennis player, Wimbledon,
and U.S. Open Champion). - Fears of the widespread dissemination of HIV
throughout professional sports have been fueled by
such reports as in 1991 when two Canadian physicians
announced a woman who died of AIDS had disclosed
that she had sexual intercourse with 30–70 different
hockey players in the National Hockey League (NHL)
(Johnston, 1994). - In intercollegiate athletics, a survey of National
Collegiate Athletic Association (NCAA) institutions
concerning HIV/AIDS policies was conducted almost
one decade ago. Eight institutions reported they had
known HIV positive athletes in their institutions that
had not been diagnosed with AIDS. These athletes
were still participating in sports at three of those insti-
tutions. Four institutions reported athletes with AIDS.
One of those was still participating in intercollegiate
athletics (McGrew et al, 1993).PATHOPHYSIOLOGYDEFINITION- HIV is a human retrovirus, which targets and infects
CD4+ T helper cells. It replicates within the CD4 cells
and causes cell death. - AIDS is a chronic illness with an average natural his-
tory of >10 years. It is the result of a progressively
immunocompromised state due to quantitative and
functional defects in CD4+ T helper cells. The decline
in CD4 cells results in decreased function of the
immune system and the development of opportunistic
infections and certain malignancies (Eichner and
Calabrese, 1994).
NATURAL HISTORY OF DISEASE•Following the initial exposure to HIV, the individual
may develop an acute and self-limited viral-like syn-
drome, or seroconversion may occur silently without
symptoms.
•Following infection and seroconversion is a period of
clinical latency that may last a decade or more.
During this time the infected person has normal per-
formance and exercise function.- As the infection progresses and the immune system
becomes compromised, the individual may develop
symptoms such as fevers, lymphadenopathy, fatigue,
and weight loss. - An AIDS defining illness occurs as the immune
system continues to decline and the infected individ-
ual becomes susceptible to opportunistic infections
ranging from mild candidiasis to life-threatening
pneumocystis carinii pneumonia(PCP). Malignancies
such as lymphoma may also arise. Muscle wasting
also occurs through mechanisms that are not com-
pletely understood (Eichner and Calabrese, 1994).
TRANSMISSION- The virus is found in all body fluids including blood,
semen, vaginal and cervical secretions, breast milk,
and amniotic fluid. The highest concentration is in
the cerebrospinal fluid(CSF). It is also found in low
602 SECTION 7 • SPECIAL POPULATIONS