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Tiredness and fatigue

Michael Carter, Greta Hughson
Published: 23 May 2012

Tiredness and fatigue are common problems among people with HIV. There are many possible causes and treatments and there are also things you can do to help you cope with fatigue. It may sound obvious, but many people feel tired during the day because they are not getting enough sleep. Insomnia, difficulty sleeping and disturbed sleep can also have several different causes and tackling them can make a big difference to your mood and wellbeing.

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 treatment and fatigue

Even though anti-HIV drugs may improve energy levels, some may also cause fatigue. Tiredness, fatigue, insomnia and sleep disturbances are possible side-effects of several anti-HIV drugs. Side-effects are most common 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 a good idea to first rule out other causes of fatigue and discuss your treatment choices with your doctor.

Drugs used to treat infections (such as cotrimoxazole, 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. Anaemia, a lack of red blood cells often caused by iron deficiency, can cause fatigue and your doctor can check for anaemia with a blood test.

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. Sometimes difficulty sleeping, or insomnia, can be caused by stress, anxiety, depression, or worrying. If you can identify what is causing you to feel these things and take steps to begin tackling any issues, you may find that your sleep improves. Support from family and friends, or help in the form of a talking therapy, like counselling or cognitive behavioural therapy (CBT) is often useful.

It can be helpful to establish a routine that balances work, relaxation, exercise, sleep and socialising. Set yourself some goals and give yourself time to adjust to your new routine. Too much coffee and alcohol can lead to fatigue, as can some recreational drugs.

Having a baby, or young children, often has a major impact on your sleep. Support from your partner, family or friends can be really important in helping you to cope. You can also talk to your health visitor or GP for advice and details of local support services.

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.

Other common medical causes of fatigue include anaemia and underactive thyroid. Being underweight or overweight can make you feel tired, as can being pregnant, particularly in the first three months of pregnancy.

What you can do

Talk to your doctor about how you are feeling and ask for their opinion and advice. You might find it helpful to prepare for your next appointment by making some notes, or keeping a diary of your sleep and how you tired you feel. You could also use our free online Talking points tool ( to help you prepare.

There are also things you can do to help you sleep, such as eating regular, healthy meals and snacks; exercising regularly; maintaining a healthy weight; making sure you drink enough water; only drinking alcohol in moderation; making time to relax; talking about how you feel with friends, family or other people you trust.

Contact NAM to find out more about the scientific research and information used to produce this factsheet.

Talking points

Talking points is designed to help you talk to your doctor about HIV treatment.

Go to Talking points >
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.
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