Tiredness and fatigue

Image: Domizia Salusest | www.domiziasalusest.com

Key points

  • Illnesses and drug side-effects can contribute to fatigue.
  • People often report an increase in their energy levels after starting HIV treatment.
  • A healthy balanced diet may help to reduce fatigue.

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. They will usually lessen or go away completely with time.

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.

Sleep disturbance, fatigue or anaemia (a condition in which there is a lack of red blood cells in the body) may also be side-effects of other medication, and are common side-effects of the hepatitis C treatments ribavirin and interferon.

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 can cause fatigue. Iron deficiency anaemia is the most common type, but it can also be caused by a lack of vitamin B12 or folate (vitamin B9). 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



Tiredness, often severe (exhaustion).



A shortage or change in the size or function of red blood cells. These cells carry oxygen to organs of the body. Symptoms can include shortness of breath, fatigue and lack of concentration.




Any form of treatment. Drugs, radiation, and psychiatric counselling are forms of therapy. 


A mental health problem causing long-lasting low mood that interferes with everyday life.

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.

"Talk to your HIV dietitian about minimising fatigue through dietary changes and supplements."

An underactive thyroid is a common cause of fatigue. Being underweight or overweight can make you feel tired, as can being pregnant, particularly in the first three months of pregnancy.

Tiredness can also be a symptom of heart disease and heart failure.

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 tired you feel.

There are also things you can do to help improve your energy levels:

  • eat regular, healthy meals and snacks
  • exercise regularly
  • get a good night’s sleep
  • maintain a healthy weight
  • make sure you drink enough water
  • only drink alcohol in moderation
  • make time to relax
  • talk about how you feel with friends, family or other people you trust.
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