Lipoatrophy Syndrome &
Facial Lipoatrophy 
Nausea & Diarrhea
Fatigue & Anemia
Emotional
Support
HIV & Nutrition
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Fatigue is tiredness that does not go away when you rest. It can be physical or psychological.
With physical fatigue, your muscles cannot do things as easily as they used to. You might notice
this when you carry bags of groceries. With psychological fatigue, it may be difficult to
concentrate for as long as you used to. In severe cases, you might not feel like getting out
of bed in the morning and doing your regular daily activities. Fatigue is one of two main ways
the body warns you of a problem.
People with HIV should be very aware
of their fatigue, and act on ways
to treat it.
Anemia is a shortage of hemoglobin, a protein in the red blood cells which carries oxygen from the lungs to the
rest of the body. If you don't have enough red blood cells, or if they aren't carrying enough oxygen,
your fatigue may be caused by anemia. A simple blood test will show whether you have anemia. If you
do, your doctor will determine what is causing anemia. It could be due to blood loss, damage to your
bone marrow caused by antiretroviral HIV medications or vitamin deficiencies, or by a low level of the
hormone erythropoietin which helps make red blood cells.
Anemia and HIV
Anemia has always been a problem for people with HIV and AIDS. The rate of serious anemia has
dropped considerably since people started using HAART (Highly Active Antiretroviral Therapy).
However, almost half of people with HIV still have mild or moderate anemia.
Anemia increases fatigue and can lower your quality of life. Many drugs used to treat HIV
and related infections also cause anemia. Treating anemia improves the health and overall
outlook of people with HIV.
As bone marrow produces red blood cells. This process requires iron, vitamins B12 and
folic acid (or folate). Erythropoietin (EPO) stimulates the production of red blood cells.
EPO is a hormone made by the kidneys.
Several factors can cause anemia:
- Too little iron, vitamin B12 or folate.
- Damage to bone marrow or kidneys
- Blood loss from internal bleeding or a woman's menstrual cycle
- Destruction of red blood cells (hemolytic anemia)
Other factors are linked to a higher rate of anemia in people with HIV:
- Lower CD4 cell counts
- Higher viral load
- Taking AZT
- African-American
- Being a woman
HIV disease progression is about 5 times more common in people with anemia. Anemia
is also linked to a higher risk of death. Treatment of anemia is essential as it seems
to lower these risks.
How Is Anemia Treated?
Treatment of anemia depends on its cause.
- First, treat any chronic bleeding. This could be internal bleeding, hemorrhoids, or even frequent nosebleeds.
- Next, correct any shortages of iron, vitamin B12 or folate.
- Stop using, or reduce the doses of medications that cause anemia.
These approaches might not work. It may not be possible to stop using all medications that
cause anemia. Two additional treatments are injections of EPO and transfusions.
EPO (erythropoietin) stimulates the production of red blood cells. In 1985, scientists learned how
to make synthetic EPO. It is injected under the skin, usually once a week. The most common brand of
EPO is Procrit®. Speak to your doctor for more information about Procrit®.
Fatigue and HIV
Fatigue can be caused by many different factors. Work with your doctor to find the cause of your fatigue and the best way to treat it.
- Active HIV infection. When HIV multiplies rapidly, your body uses a lot of energy trying to fight it. Most people have more energy after they start taking antiretroviral HIV medications.
- Poor nutrition. People with HIV need more energy than healthy people. If you are not getting enough nutrients, your energy level will be low. Diarrhea can rob your body of nutrients and cause fatigue. If possible, meet with a dietitian who knows about HIV disease to discuss your eating habits. For some people, vitamin B12 supplements or better nutrition can eliminate fatigue.
- Depression. This is more than just feeling sad. Chemical changes in the brain can cause fatigue and a lack of interest in daily activities. There is no blood test for depression. The chances that you are depressed are higher if you have previously been diagnosed with depression, if you have a history of heavy alcohol or recreational drug use, or if you have a family history of emotional disorders. Depression can be treated with medications. However, some antidepressants can cause problems with sexual functioning. Also, some antidepressants interact with some antiretroviral HIV drugs, so they must be used very carefully.
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