Fatigue

Fatigue refers to unusual and persistent tiredness or lack of energy. It is commonly seen in HIV-positive people, at rates ranging from 35 to 65% in different studies.1 2 While it may have a variety of causes including depression, low testosterone, thyroid dysfunction, and viral hepatitis, fatigue often occurs as a side effect of antiretroviral therapy.

All approved anti-HIV medications have been linked to fatigue in at least some patients. One of the most common offenders is AZT (zidovudine, Retrovir), due to its propensity to cause anaemia. Drug-related fatigue is usually mild and improves as the body adjusts to new treatment. However, it may also be a sign of more serious forms of drug-induced toxicity, including abacavir (Ziagen) hypersensitivity reaction, mitochondrial toxicity, lactic acidosis, or liver toxicity.

Fatigue has three aspects: physical, mental, and emotional. Physical fatigue may be characterised by muscle weakness and reduced ability to carry out daily tasks. People with psychological fatigue may find it difficult to concentrate or think clearly. Emotional fatigue involves lack of motivation and loss of interest in formerly enjoyable activities.

Pharmaceutical treatment for fatigue includes antidepressants such as fluoxetine (Prozac) and sertraline (Zoloft). Mild tranquillisers may be helpful if a person has trouble sleeping at night. Some researchers are exploring the use of psychostimulants, such as methylphenidate (Ritalin) and modafinil (Provigil), to treat fatigue.3 4 However, this is controversial and unapproved. As for alternative and complementary therapies, some people find that acupuncture, yoga, t'ai chi, and massage enhance their energy and improve quality of life. Most forms of exercise and simply spending some time in the sun can improve spirits and boost energy. 

Management of fatigue relies heavily on practical measures, including:

  • Getting enough sleep at night.
  • Eating a balanced diet.
  • Getting regular moderate exercise.
  • Taking rests, as needed, during the day.
  • Cutting back or stopping alcohol, tobacco, and recreational drugs.
  • Reorganising the home and workplace to maximise efficiency and minimise effort.
  • Scheduling the most demanding activities for times of the day when energy is highest.
  • Asking friends, family, or service agencies for help with daily tasks.

References

  1. Sullivan PS et al. Prevalence and correlates of fatigue among persons with HIV infection. J Pain Symptom Manage 25: 329-333, 2003
  2. Henderson M et al. Fatigue among HIV-infected patients in the era of highly active antiretroviral therapy. HIV Med 6: 347-352, 2005
  3. Breitbart W et al. A randomized, double-blind, placebo-controlled trial of psychostimulants for the treatment of fatigue in ambulatory patients with human immunodeficiency virus disease. Arch Intern Med 161: 411-420, 2001
  4. Rabkin J et al. Modafinil treatment for fatigue in HIV patients: a pilot study. J Clin Psychiatry 65: 1688-1696, 2004
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
close

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.