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Fatigue in People Living With HIV

By Dr. Harold Dion

Dr Harold DionHarold Christian Dion studied medicine at the University of Ottawa and Family Medicine at McGill University.

He has worked at the Clinique médicale l’Actuel in Montreal for the past 25 years.

He is also co-editor-in-chief of e-Relais VIH, a Canadian bilingual online publication for patients living with HIV.

Over the past 10 years, Dr. Dion has published several articles on various health issues, for both general public (Coup de pouce, 7 Jours, Reader’s Digest) and healthcare professionals (L’actualité médicale, Le Clinicien, L’Omnipraticien, MedActuel FMC, Le Médecin du Québec). 

Fatigue is a very common symptom experienced by people living with HIV, even in those with an undetectable viral load and a relatively high CD4 count.

What are the causes of fatigue in people living with HIV?

The most common causes of fatigue are unhealthy habits, psychological disorders, certain medications, or certain physical illnesses. As a result, it is important to do a proper medical evaluation of the patient, in order to rule out non-HIV-related causes, which can be treated.

Psychological disorders that cause fatigue include depression, excessive stress (e.g. domestic problems, conflicts at work, work overload, financial problems, etc.) or an adjustment disorder (e.g. separation, moving, changing jobs).

As for unhealthy habits, an unhealthy diet (high in sugar and fat, and/or low in fruits, vegetables and fibre), physical inactivity, sleep disorders (e.g. insomnia, sleep apnea), tobacco use, as well as excess caffeine, alcohol or drugs, can all cause fatigue.

In addition, certain medications, such as antihistamines, anxiolytics, antidepressants, sleeping pills, antihypertensives and antiretroviral drugs, are likely to cause fatigue.

Finally, some physical illnesses may also bring about fatigue (see Table 1). It is therefore recommended to screen the patient for anemia, diabetes, thyroid gland disorders, abnormal hormone levels, co-infections, sleep disorders, and so on.

Table 1: Physical illnesses than can cause fatigue

  • Anemia
  • Diabetes
  • Hypoglycemia
  • Severe hypertension
  • Hepatitis B or C
  • Infection
  • Allergies
  • Hypo- or hyperthyroidism
  • Arthritis
  • Cardiac insufficiency
  • Chronic pulmonary insufficiency
  • Renal insufficiency
  • Inflammatory bowel disease
  • Neurological disease (e.g. multiple sclerosis, Parkinson’s disease, etc.)
  • Menopause
  • Andropause
  • Cancer
  • Etc.

What is the treatment of fatigue for people living with HIV?

An integrated approach is recommended to treat fatigue in people living with HIV. A good starting point is to recommend a healthy and balanced diet combined with physical activity that the person enjoys and can incorporate into their daily life, such as gardening, taking the stairs, walking to the store, walking in the woods, etc., in order to increase their chances of persisting in this activity.

Psychotherapy and in some cases an antidepressant may alleviate depression. Physical activity, breathing exercises, yoga and meditation can reduce the effects of stress. It is also important for the person to address any sleep disorder, including sleep apnea, and curb their intake of medications that can cause fatigue. It may be necessary to adjust their antiretroviral therapy. If alcohol or drug use is problematic, it is advisable to refer the person to an addiction counselling.

Finally, for fatigue associated with a physical illness, the treatment depends on the cause. For example, any diagnosed infection should be fully treated, and a testosterone or thyroid deficiency can be alleviated through hormone replacement therapy. Treatment for anemia will be covered in a future article. For more information, please see the references below.

Payne B, et al. “HIV-associated fatigue in the era of highly active antiretroviral therapy”. HIV Medicine. Apr. 2013; 14(4):257-51.
Jong E, et al. “Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era”. AIDS. June 19, 2010; 24(10):1387-1405.

Image: Statue of the Tired Man, by József Somogyi