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Fatigue and AnemiaFatigue and Anemia
           
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asymptomatic
Feb 10, 2001

I don't understand this asymptomatic phase. In all the years I have been HIV+, being hot and sweaty and fatigued have been symptoms. Do some HIV+ just have symptoms from the beginning??

Response from Dr. Frascino

Hi, Yes, indeed. Every person's response to the virus is different. The differences have to do with a wide variety of factors including how each individual's immune system functions, and the exact type of virus contracted. We use the term "asymptomatic" to describe a common course of events where a person contracts the virus, then may develop an "acute sero-conversion reaction" which often includes flu-like symptoms which subsequently resolve. The person may then experience a period of time when they are essentially symptom free. Their own immune system is controlling the virus. In so-called "long term non-progressers" this period may last indefinitely. These lucky folks are, unfortunately, only a very small minority of those of us infected with the virus. Most of us will eventually begin to have additional symptoms as our immune system begins to fail as a result of ongoing viral replication; hence the need for anti-viral medications to slow the virus down. We are now trying to develop ways of stimulating the immune system -- to make us all "non-progressers".

Your sweats are a quite common symptom in viral infections -- including HIV. However, you should also be checked for possible opportunistic infection. As I mentioned, HIV eventually takes its toll on our immune systems. This leaves us vulnerable to infections that normally wouldn't bother us -- opportunistic infections. These infections are taking the "opportunity" of our immune systems being damaged to cause problems. These obviously occur more frequently as our immune systems deteriorate. So, depending on your CD4 count you may need to be checked for an opportunistic process. If there is no evidence of another infection, then you can assume its HIV.

Fatigue is the most common complaint of those of us infected with this pesky virus. The potential causes are many and I would suggest you evaluate them thoroughly. As it turns out, the cause of our fatigue frequently winds up being not an isolated thing but rather a combination of factors. The most common causes include 1) inadequate rest, diet, and/or exercise, 2) hormonal imbalances such as decreased testosterone in men, 3) occult infection 4) depression/anxiety 5) medication side effects 6) HIV itself and 7) anemia. This is only a partial list but at least it's a start. With your chronic fatigue you should certainly discuss potential causes with your HIV specialist. Check to see if your testosterone is low (if you are a man). Testosterone replacement therapy is easy and very effective. Check also to see if your hemoglobin is low. Treatment of HIV-related anemia with Procrit has demonstrated dramatic improvements in energy levels and quality of life. In addition, there is also an association with improved survival.

Some folks just get used to being tired all the time and adjust to the condition. They may consider themselves "asymptomatic", but when you really talk to them you realize they don't have the "get up and go" they used to have. Many folks might feel it's just part of being HIV positive -- and sometimes it is. But often our fatigue is complicated by anemia or any of the other conditions I mentioned. Treating the treatable components of our fatigue is essential to our overall quality of life.

Hope this helps.

RJF


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