Fatigue remains common in people with HIV, and often connected with social factors and mental health issues

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The prevalence of fatigue amongst people with HIV ranged from between 33% and 88% in 42 studies examined in a review article in the online edition of the AIDS.

Fatigue was strongly associated with psychological factors, such as anxiety and depression. Evidence supporting the use of medication to treat fatigue was limited. However, research showed that the use of cognitive behavioural therapy (CBT) as a treatment had some success.

Thanks to antiretroviral therapy, many patients with HIV can look forward to living a long and healthy life. But individuals with HIV still report a high burden of symptoms, one of which is fatigue.



Tiredness, often severe (exhaustion).



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


A feeling of unease, such as worry or fear, which can be mild or severe. Anxiety disorders are conditions in which anxiety dominates a person’s life or is experienced in particular situations.


The general term for the body’s response to injury, including injury by an infection. The acute phase (with fever, swollen glands, sore throat, headaches, etc.) is a sign that the immune system has been triggered by a signal announcing the infection. But chronic (or persisting) inflammation, even at low grade, is problematic, as it is associated in the long term to many conditions such as heart disease or cancer. The best treatment of HIV-inflammation is antiretroviral therapy.

gastrointestinal (GI) symptoms

Relating to or affecting the gut, stomach or bowel. GI symptoms include diarrhoea, abdominal pain (cramps), constipation, gas in the gastrointestinal tract, nausea, vomiting and GI bleeding. Among several possible causes of GI symptoms are infections and antiretroviral medicines.


Fatigue has been defined as “a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a feeling of tiredness that is not reduced by a good night’s sleep.”

The consequences of fatigue can include a diminished ability to work or maintain social contact. Quality of life can also be reduced, a factor associated with disease progression.

Therefore, Dutch investigators conducted a literature review to identify the latest evidence regarding the causes and treatment of HIV-related fatigue in the era of antiretroviral therapy.

A total of 42 studies conducted between 1996 and 2008 were identified. The largest study included 1200 individuals, and the smallest just 19 patients. Most had a cross-sectional design.

Sociodemographic factors and fatigue

Poverty and low income were associated with fatigue in four studies. There was no consistent evidence linking either gender or ethnicity an increased risk of reporting fatigue.

Perhaps surprisingly, fatigue appeared to be more prevalent in younger rather than older patients, a finding which the investigators believe could be because older patients have developed better strategies to cope with fatigue.

HIV-related factors

The was no consistent evidence demonstrating that experiencing other HIV-related symptoms was associated with fatigue. However, when symptoms were associated with fatigue, fever, gastrointestinal problems, and neuropathy predicted greater fatigue severity.

Neither CD4 cell count nor viral load appeared to be associated with fatigue. Patients who had been living with HIV for longer were less likely to report fatigue than those who had been diagnosed more recently.

Elevated levels of interleukin-6 (IL-6) and other markers of inflammation were not associated with fatigue.

Physiological factors

Generally, the presence of co-infections such as hepatitis B or hepatitis C, as well as co-morbidities were associated with more severe fatigue.

Low levels of haemoglobin were not significantly associated with fatigue, but there was some evidence that patients with lower testosterone were more likely to report the condition.

There was no consistent evidence that fatigue was linked to body composition, weight, or body mass index.

Although total reported sleep was not associated with fatigue, daytime napping was.

Psychological factors

Stress, depression, anxiety and poor coping strategies were all consistently related with greater severity of fatigue.

Treatment of fatigue – medication

A wide range of medicines were used to treat fatigue including testosterone, antidepressants, and psycho-stimulants. But the evidence for their efficacy was limited.

Treatment of fatigue – psychological interventions

Two studies showed that psychological interventions, such as cognitive behavioural therapy, had benefits for HIV-related fatigue.

“Studies on the treatment of HIV-related fatigue are minor in nature and focus on a selected group of patients”, comment the investigators.

They conclude, “treatment for HIV-related fatigue is important because of its social, psychological and behavioural consequences and requires a multidisciplinary approach. There is a need for an appropriate evidence-based practice guide for the management of HIV-related fatigue.”


Jong E et al. Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era. AIDS, 24: online edition, DOI:10 .1097/QAD.0b0113e3283339d004, 2010.