WHAT IS FATIGUE?

Fatigue is tiredness that does not go away when you rest. It can be physical or psychological.

With physical fatigue, your muscles cannot do things as easily as they used to. You might notice this when you climb stairs or carry bags of groceries.

With psychological fatigue, it may be difficult to concentrate for as long as you used to. In severe cases, you might not feel like getting out of bed in the morning or doing your regular daily activities.

IS FATIGUE IMPORTANT?

Fatigue is one of two main ways the body warns you about a problem. The other warning is pain. Most of us pay attention to pain and stop whatever causes us pain. We don’t pay as much attention to fatigue. One reason might be that fatigue sneaks up on us: it usually gets worse so slowly that we don’t even notice.

People with HIV who have fatigue tend to get sicker faster than people who do not have fatigue. Also, ongoing fatigue can weaken the immune system. People with HIV should find out what is causing their fatigue and treat it.

HOW DO I KNOW IF I HAVE FATIGUE?

Fatigue can start and increase very slowly. If you feel tired even after you rest, talk with your healthcare provider about fatigue. Give your healthcare provider as much information as possible. This will make it easier to know if you are fatigued and what might be causing it. The following questions are good to think about before you talk to your healthcare provider about fatigue:

    • How long have you been tired?
    • Compared to a few months ago, how has your activity level changed?
    • How do you feel when you are tired? Are you short of breath? Are your muscles sore? Is it difficult to concentrate or remember? Is it hard to get interested in your daily activities?
    • When are you tired? Is it after certain activities, like climbing stairs? Do you wake up tired?
    • Are you sleeping well? How long do you sleep each night? How many times do you get up? Is it hard to fall asleep or stay asleep because of stress, physical pain, or other problems?

WHAT CAUSES FATIGUE AND HOW IS IT TREATED?

Fatigue can be caused by many different factors. Work with your healthcare provider to find the cause of your fatigue and the best way to treat it.

Active HIV infection: When HIV multiplies rapidly, your body uses a lot of energy trying to fight it. Most people have more energy after they start taking antiretroviral medications (ARVs).

Other active infections: Other infections can tire you out, even without obvious symptoms. Parasites in your digestive system, bronchitis, other infections, or allergies can cause fatigue. If these infections are treated your energy should improve. Read more about opportunistic infections (OIs).

Poor nutrition: People with HIV need more energy than healthy people. If you are not getting enough nutrients your energy level will be low. Diarrhea can rob your body of nutrients and cause fatigue. If possible, meet with a dietitian who knows about HIV to discuss your eating habits. For some people, vitamin B12 supplements or better nutrition can eliminate fatigue.  

Anemia: The main job of red blood cells (RBCs) is to carry oxygen from the lungs to the rest of the body. If you don’t have enough RBCs, or if they aren’t carrying enough oxygen, your fatigue may be caused by anemia. A simple blood test will show if you have anemia.

If you do, your healthcare provider will determine what is causing anemia. It could be due to blood loss, damage to your bone marrow caused by ARVs, vitamin deficiencies, or by a low level of the hormone erythropoietin (EPO) which helps make RBCs.

Low hormone levels: Especially in men, low levels of the sex hormone testosterone can cause fatigue and lack of interest in sex and other normal activities. Low levels of other important hormones such as DHEA, cortisol, or thyroid can cause similar problems. Hormone levels can be checked with blood tests. Pills, patches, creams, or injections can restore hormone levels to normal. 

Depression: This is more than just feeling sad. Chemical changes in the brain can cause fatigue and a lack of interest in daily activities. There is no blood test for depression. The chances that you are depressed are higher if you have previously been diagnosed with depression, if you have a history of heavy alcohol or recreational drug use, or if you have a family history of emotional disorders. Depression can be treated with medications. However, some antidepressants can cause problems with sexual functioning. Also, some antidepressants interact with some ARVs, so they must be used very carefully. 

Lifestyle: Getting enough sleep is important. Habits like smoking or drinking a lot of coffee can make it harder to sleep. Regular exercise can make it easier to sleep. 

THE BOTTOM LINE

Fatigue is a very common condition for people with HIV. Untreated fatigue can make HIV progress faster.

It can be very difficult to figure out the cause of fatigue. Several different factors can cause the same symptoms. Blood tests can identify some causes but not others. The more information you can give your healthcare provider, the easier it will be to determine what is causing your fatigue and how to treat it.

MORE INFORMATION

nam aidsmap: Tiredness and Fatigue

healthline: Best Ways to Battle HIV Fatigue

TheBodyPro: A Comprehensive Look at HIV-Related Fatigue

 Reviewed July 2024

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