Many people who are living with HIV experience fatigue. It may be directly related to HIV or indirectly related through medications, psychological effects, or life stress.
In this article, we look at the causes of HIV-related fatigue, how to overcome fatigue, and the effects HIV has on a person’s mental health. An unusual level of fatigue, along with other symptoms, can be an early symptom of HIV.
- Fatigue can be an early symptom of HIV.
- HIV-related fatigue is often related to psychological factors, such as life stress, anxiety, and depression.
- Some HIV medications can cause fatigue. However, people usually experience an increase in energy after beginning antiretroviral therapy.
- Looking after mental and physical health can help improve fatigue.
Why does HIV cause fatigue?
Sometimes, HIV causes fatigue because of its impact on a person’s immune system. Other times, additional health conditions, treatment factors, or psychological factors are responsible.
Some sources claim that fatigue is the most problematic and frequent symptom in people with HIV. Although a 2010 research review states that 33 to 88 percent of people with HIV experience fatigue, estimates vary as fatigue is difficult to define and measure.
According to 2018 research, the following factors have links with HIV-associated fatigue:
- chronic inflammation
- poor nutrition
- medication side effects
- changes in the brain
- social isolation
- sleep hygeine
- a lack of activity
- substance use
Fatigue can have a significant effect on a person’s wellbeing and quality of life. Because fatigue can make a person feel tired but unable to sleep, it can impact their motivation and decision-making abilities.
Fatigue can also weaken a person’s immune system, which can make HIV progress more rapidly. It is essential to find out the cause of the fatigue and to treat both the cause of the fatigue and HIV.
Potential causes of fatigue for people with HIV include:
After a person contracts HIV, their immune system responds by trying to fight off the virus. The effort involved in trying to defend the body against HIV causes fatigue in people, especially in the early stages before treatment has begun.
HIV can also cause fatigue because it impairs immune system function. Most people report an increase in energy after beginning to take antiretroviral medication.
Fatigue is among the early symptoms of HIV that can appear within the first 2–4 weeks after a person has contracted the virus, along with other flu-like symptoms, such as:
- muscle aches
- swollen lymph nodes
- mouth ulcers
Anemia is one of the most common blood-related complications of HIV. Among other symptoms, anemia can cause fatigue, dizziness, and concentration problems.
Research suggests that HIV-associated anemia has similarities to the type of anemia that occurs as people age. Scientists think this is due to the expression of molecules called pro-inflammatory cytokines that cause anemia and inflammation in older people.
Stress can have a major impact on a person’s quality of life. The American Institute of Stress (AIS) lists 50 common symptoms of stress, including constant tiredness, weakness, and fatigue.
The AIS also note that people with HIV may be more susceptible to stress. It is essential that people with HIV treat and combat their stress, which might help alleviate some of the symptoms of fatigue.
HIV has links to various psychological issues, such as depression and anxiety, which can also contribute to fatigue. Sometimes, the uncertainties surrounding an HIV diagnosis can cause anxiety. Other people experience depression, which may result in a low quality of life and poor adherence to HIV treatment.
A person with HIV may also experience fatigue that is caused by unrelated conditions. These conditions may have existed before a person received an HIV diagnosis or developed afterward.
Some underlying conditions that can contribute to fatigue include:
- underactive thyroid (hypothyroidism)
- not producing enough testosterone (hypogonadism)
HIV compromises a person’s immune system by attacking and weakening the cells that typically protect the body from other forms of infection. This means that people living with HIV are more likely to contract viral and bacterial infections that they might not get otherwise. These are known as secondary or opportunistic infections.
Opportunistic infections are more likely to occur when a person is not taking antiretroviral medications and has a very low CD4 count. CD4 cells play a vital role in keeping the immune system healthy. Taking HIV medication will prevent HIV from damaging the immune system, and allow the CD4 count to increase, which signals a boost in immune system function.
Possible HIV-related opportunistic infections include:
- oral or vaginal thrush also called candidiasis
- herpes simplex 1 (HSV-1), which causes cold sores around the mouth
- salmonella, a bacterial infection that causes nausea and diarrhea
- toxoplasmosis, an infection that can affect the brain
Additional causes of fatigue for people with HIV may include:
- a side effect of HIV medications
- hormonal imbalances
- use of allergy medications, such as antihistamines
- an unhealthful diet
- overwork or too much physical activity in a day
- alcohol or recreational drug use
- fatigue with no known cause, which is called idiopathic fatigue
How to overcome fatigue
The most effective treatment for fatigue will depend on its cause.
The best treatment for HIV-related fatigue is usually taking antiretroviral medications. People typically experience a boost in energy levels when they begin to take antiretroviral drugs, which is a sign that their immune system is recovering.
People who do not know what is causing their fatigue should consider keeping a journal to note down the times when they feel the most fatigued. This may help the person identify the exact cause of the fatigue and give healthcare providers a better idea of how to combat it.
Some possible treatments for fatigue include:
- treating the underlying condition, such as depression, stress, or insomnia
- switching medications or ask about alternatives if medications seem to be the issue
- eating a more healthful diet
- reducing physical demands throughout the day if possible
- avoiding alcohol and recreational drugs
Mental health effects of HIV
According to the U.S. Department of Health and Human Services, people with HIV experience “higher rates of mental health conditions than the general population.” It is essential that people with HIV look after their mental health and a range of treatments is available.
Anyone experiencing the following symptoms may benefit from seeking help for their mental health:
- high stress or anxiety levels
- a feeling of emptiness or sadness
- finding less enjoyment in things they used to enjoy
- thoughts of suicide
The following treatments can help improve a person’s mental health:
- speaking to a psychologist, psychiatrist, social worker, or another therapist
- developing a strong social support network
- joining support groups of people with similar issues
- trying meditation
- maintaining or increasing healthful habits, such as eating well and moderate exercise
- taking medications
Fatigue is a symptom commonly associated with HIV. The condition can cause fatigue because of its impact on the immune system, which can lead to anemia, stress, and other psychological conditions.
People can improve their energy levels and combat fatigue by taking antiretroviral therapy for HIV and treating the underlying causes of fatigue, which may include mental health support.
A person should work with their healthcare providers to determine the root cause of their fatigue so that they can better manage the underlying cause of their fatigue.
Medically reviewed by Daniel Murrell, M.D.
Written by Jenna Fletcher