June 10, 2010

Fatigue Common in People With HIV, Often Linked to Psychological Factors

Up to 88 percent of people with HIV experience fatigue, and psychological problems appear to be one of the most likely culprits, according to a study published online June 2 in AIDS.

Fatigue has historically been a common problem among people living with HIV, with prevalence rates approaching 90 percent in some studies. Untreated fatigue can lead to unemployment and social isolation, and it can reduce people’s ability to effectively care for themselves.

To examine fatigue in HIV disease in the modern treatment era, Eefje Jong, MD, of Slotervaart Hospital in Amsterdam, and her colleagues analyzed data from 42 studies published between January 1996 and August 2008. In addition to wanting to learn more about the prevalence of fatigue in more recent years, the researchers set out to understand the factors—including demographic, physiological, psychological and HIV-specific issues—associated with the condition. They also hoped to gain a better sense of the most effective treatment modalities for the condition.

In previous studies, researchers have found that between 20 and 60 percent of people with chronic HIV infection, and up to 85 percent of people with an AIDS diagnosis, have suffered from fatigue at one time or another. In the studies reviewed for Jong and her colleagues’ analysis, fatigue prevalence rates ranged from 33 to 88 percent.

The demographic factors most consistently predictive of fatigue were younger age and unemployment. The authors hypothesized that older people might report less fatigue because they had more effective coping strategies or more time to adjust to medication regimens. Studies that examined race, sex and income were not consistent, though lower income was associated with greater fatigue in at least one study.

In terms of HIV-related issues, CD4 and viral load were not consistently linked with fatigue, though people with more HIV-related symptoms were more likely to have the condition. Studies on comorbid conditions—such as diabetes and hepatitis B or C—were mixed, with some studies finding a connection with fatigue and others showing no connection at all.

Surprisingly, body weight and composition appeared to have no bearing on fatigue, nor did blood levels of proteins related to inflammation, such as interleukin-6 (IL-6) or tumor necrosis factor (TNF) alpha. Some studies showed that lower testosterone levels predicted fatigue, but others did not.

Of all the factors considered, psychological disorders—particularly depression and anxiety—had the strongest and most consistent connection with fatigue. Sleep problems also predicted fatigue. Though the total hours a person slept didn’t have an impact, people who napped during the daytime were more likely to suffer with the problem.

Finally, while a number of treatments for fatigue were explored in the studies, medication was not consistently helpful. Medications with the strongest evidence of fatigue treatment were testosterone and psychostimulants, including Adderall (dextroamphetamine) and Ritalin (methylphenidate hydrochloride). Non-medicinal interventions were more helpful, however, especially cognitive behavioral therapy.

Graded exercise therapy (GET) is another possible option to fight fatigue. With GET, a person logs his or her daily activity and increases it to the point where the exercise begins to worsen symptoms. GET has been successful in HIV-negative people with chronic fatigue syndrome, but no good recent studies focused on HIV-positive people. Though exercise and fatigue studies have been conducted in people with HIV, the authors chose not to include any of them in their analysis, because none used a validated instrument for assessing fatigue either before or during the exercise intervention.

“Currently the evidence for interventions with medication is not strong,” the authors said. “Behavioral interventions and GET seem more promising.”

Because fatigue is so common, and so dramatically reduces a person’s quality of life, the authors urge care providers to assess their patients for the condition. The researchers state that “in case of fatigue, clinicians should not search only for physical mechanisms, but should question depression and anxiety in detail.”

Finally, the authors are calling on researchers to develop an evidence-based approach to screening and treating fatigue in people with HIV.

Search: Fatigue, HIV, Eefje Jong, depression, anxiety, race, Adderall, Ritalin, psychostimulants, testosterone, graded exercise therapy, GED, psychological, Hepatitis C, Hepatitis B, liver

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Previous Comments:

Enigmadave, Auburn, New York, 2010-09-09 13:33:13
I can understand the findings and agree that this virus causes considerable stress both emotionally and physically. I believe that in many instances a medical intervention is not warranted,but, in some cases may actually be what is needed. A great deal depends on the patient as well as the perception of that patient by his/her physician.

Keith, Scappoose, OR, 2010-09-08 23:32:51
George, you are way off base. I have suffered from depression for over 50 years. I have attempted suicide several times and have voluntarily admitted myself to mental health wards several times. I have tried probably over 20 different meds to help with my depression. At times I was unable to even get out of bed for months at a time. I finally found a combination of meds that make it possible for me to have a fairly "normal" life. Without them I would have killed myself a long time ago.

Andrea, Redwood City, 2010-08-03 01:24:10
WHAT ROT! I had fatigue even before I was diagnosed.

Jerry Robbins, Saint Petersburg, 2010-07-30 21:10:42
It really is the medicine don't let them fool you. It is also the virus I felt fatigue before and worse after I started meds years ago, so their not fooling me

Marilyn, puerto rico, 2010-07-25 21:53:10
I have been full-blown aids, hiv pos and living with hiv all you want to call it and onething that has been constant in all these stages is the fatigue. I agree the doctors don't care to listen or many they have been trained not to listen. What the hell they don't care.

fred, , 2010-07-18 02:06:20
george,you are STUPID! ur saying not to treat depression/fatigue in ppl w/hiv,but fix the cause.....yeah dude,we're all waiting for a darned cure but it isnt coming,hence the depression.get it?

Anthony Ishola, Namibia, 2010-07-11 07:39:59
why do hiv/aids patients abandon treatment?

KAL, Raleigh, 2010-07-02 09:10:06
The results of GET in CFS patients have been very mixed with only modest results at best. Multiple research definitions are part of this and part because the results relied on self report and did not account for the dropout rate the last number carried forward. Although abnormal fatigue is a common symptom in infectious diseases such as AIDS and ME/CFS, only ME/CFS has exercise intolerance. This is medically defined as post exertional malaise lasting 24-hours unrelieved by rest w/o exertion.

Marc, Newark, Ca., 2010-06-29 13:32:26
I have to agree with all of those before me, Doctors do not listen, just want, no dying to get you to try something new. 20 years is a long time for the body to work hard at restoring itself and top off the side effects. I hit AIDS level twice, second time it has been a slow recovery and Atripla is no cake walk with sleep, but the dreams are something else. still tried after sleep. coffee has little to help unless its strong. I did get depressed after losing my job and not finding work. cold winters alone do not help either. Just find the cure and stop milking us to death. I am tired of it.

mike, boston, 2010-06-27 08:06:03
I find reading the study ridiculous. I know chronic fatigue is caused by HIV. I have had HIV since 1983 and I'm 60 years old with a very supportive partner of 29 years and have a very happy life. I have been diagnosed as not depressed. I work out four times a week but I sleep 12 hours a night and take a nap during the day. More studies done on this subject. I just don't buy the "psychological" reason for chronic fatigue.

G-B, USA, 2010-06-22 02:10:54
I'm fatigued by stigma. The collective attitudes about HIV have plum wore me out. Healthy otherwise.....................

Phil, henderson, 2010-06-20 23:37:55
Was diagnosed with aids 5 yrs ago..through rigorous exercise have been undetectable for over 4yrs. Even though the exercise makes me tried. My energy levels have increased as my counts went down. Also on testosterone therapy I'm 55 yrs old..Please give exercise a try.Even a dialy walk will make a huge difference.happy life to all

Dances-with-Puppies, Scottsdale, AZ, 2010-06-18 21:19:58
I completely agree with cinderkeys. The shrinks got the cart before the horse (like again). Who wouldn't go a bit batty when between the virus and the damn meds you can't lift your head off the pillow. It's like saying psych problems cause cancer patients to feel shitty. What a dumbass conclusion.

Tim, Pittsburgh, 2010-06-18 13:21:41
Well, stop the presses! Another inane study!You mean having a long-term debilitating condition might cause some fatigue? This kind of research -- a meta-analysis, actually -- infuriates me since they examined 42 previous studies that indicated fatigue as a co-morbidity! I guess that's why it's called a chronic condition.

George, Coos Bay, 2010-06-18 03:22:07
You people are STUPID! First of all, it doesn't help anyone who is suffering from depression to give them pills of any kind. The person thinks I am so sad that I have to take pills. THAT JUST MAKES THEM MORE DEPRESSED! DA If you want to help you have to fix what is causing the depression in the first place. Pills only makes them worse.