Tiredness and fatigue

Extreme tiredness, sometimes called fatigue, is common amongst people with HIV. There are many possible causes and treatments. There are also things you can do to help you cope with fatigue.  

HIV as a cause of fatigue

HIV is a chronic (long-term) infection and the body mounts a strong immune response against it. People with HIV may use a lot of energy because they are constantly battling the virus. This means that fatigue might slowly develop because the body is working so hard to fight HIV.

You may be more likely to develop fatigue if you have a high viral load. High viral load is particularly associated with fatigue. The aim of HIV treatment is to reduce the amount of HIV in the blood to        undetectable levels. People often report an increase in their energy levels after starting HIV treatment.

 

HIV-related medications and fatigue

Even though anti-HIV drugs may improve energy levels, some may also cause fatigue. This sometimes happens in the first few weeks after starting HIV treatment.

If you think your anti-HIV drugs are causing fatigue, a change in treatment may help. It's first a good isea to rule out other causes of fatigue and discuss your treatment choices with your doctor

Drugs used to treat infections (such as co-trimoxazole, dapsone and pyrimethamine used to treat PCP and toxoplasmosis, and ganciclovir used to treat CMV) may also cause fatigue. Folinic acid may be taken as treatment.

If your fatigue is due to drug treatment, and you can't stop taking the problem drug, you can be treated with a blood transfusion. This gives you a quick burst of red blood cells, but it is not a long-term solution.  Another short-term option may be injections of a hormone called erythropoietin which stimulates the production of red blood cells.

 

Low levels of vitamins and minerals

Fatigue may be caused by low levels of certain vitamins and minerals. A nourishing, balanced diet may reduce fatigue. So it's a good idea to consult an HIV dietitian about minimising fatigue through dietary changes and supplements.

Even if you are eating well, you may not be absorbing the goodness from the food you eat due to diarrhoea, stomach bugs or opportunistic infections. Your doctor can investigate and treat the cause of vitamin and mineral deficiencies.

Sleep, stress and depression

You can develop fatigue if you are having difficulty sleeping. You may want to establish a routine that balances work, relaxation, exercise, sleep and socialising. Too much coffee and alcohol can lead to fatigue, as can the taking some illegal drugs.

Stress and depression may cause fatigue. Help is available, so it's a good idea to consult your doctor about possible treatment such as counselling or antidepressants.

Other medical causes of fatigue

Even a minor illness like a common cold can leave you feeling tired out, even after the symptoms have gone. Some more serious infections, like pneumonia or tuberculosis (TB) can involve very serious tiredness, and you should expect to feel worn out and take things easy for weeks after you’ve taken treatment for these infections.

Low levels of hormones, particularly testosterone may cause fatigue. If a test shows that you have low levels of this hormone, your doctor may be able to give you testosterone tablets, patches, or injections until the problem is sorted out. Sometimes steroids may be used to give you energy and build muscles, in conjunction with regular exercise.