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How tired is Fatigued?
Jan 22, 2001

My brother is HIV+. From reading previous questions, I see that fatigue is a common complaint. How do you know when you have hit the level of "fatigue". My brother is constantly tired and weak. He is unable to stand or work for more than about two hours/day. He also complains of trouble digesting food and sudden "episodes" of increased weakness/fatigue that is nearly unbearable. He says it is like driving w/the emergency break on or the worst flu-type body aches, but constant. Is this a typical HIV fatigue case or is something else going on? The Doctor has run all kinds of blood work and found nothing. He has seen a cardiologist and an ENT, nothing. The Doctor thought it was Sleep Apnea, but we have been waiting for more than 6 months for the referral to the sleep clinic. Now they think it might be Autonomic Neuropathy. Is this a common problem for HIV? LD in CA

Response from Dr. Frascino

Hi LD,

How do we actually define "fatigue"? Well, first of all it is not a disease but rather a symptom of disease and while the concept seems obvious, there are actually several medical definitions of the symptom. This is because fatigue is a multidimensional term used to describe feelings of exhaustion, sleepiness, and general lack of energy. Fatigue may include: 1) physical fatigue -- such as unusual tiredness after physical exertion, 2) mental fatigue -- such as difficulty concentration, or 3) motivational fatigue -- such as lack of desire to engage in emotional or physical activities.

Fatigue can be either acute or chronic. Acute fatigue is generally short-lived, sudden in onset, and relieved by rest. In contrast, chronic fatigue lasts a long time, is usually insidious in onset, and usually not relieved by rest.

From your report, your brother certainly is suffering from some type of chronic fatigue problem. There are many potential causes of fatigue in those of us who are HIV positive and frequently more than one cause may be involved. That is why it is important to investigate all the possible causes -- anemia, hormonal imbalances, medication side effects, inadequate rest, diet, and depression/anxiety just to name a few. Your brother's body aches and digestion problems may well be a clue to some of the underlying problems. He is correct in having these symptoms worked-up thoroughly.

Regarding autonomic neuropathy -- this condition occur in approximately 10% of people with HIV-related neuropathy. Symptoms may include fainting, orthostasis, impotence, diarrhea, and urinary dysfunction. This condition can occur at any stage of infection from quite early to very late. Your brother should continue to work closely with his HIV specialist to identify if this is indeed part of his problem. A referral to an HIV knowledgeable neurologist and gastroenterologist may be warranted. This can be a difficult and frustrating problem to deal with. Diabetics are the other group of patients who not infrequently develop autonomic neuropathy.

Don't forget to continue to look for other contributing causes to your brother's fatigue problem -- including checking for anemia, low testosterone or an occult opportunistic infection.

Best of luck with this difficult situation. Stay proactive!

RJF


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