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WAITING FOR A REPLY FROM DR. BOB??? PLEASE READ THIS!
Oct 26, 2006

WAITING FOR A REPLY FROM DR. BOB???? PLEASE READ THIS!

Response from Dr. Frascino

Hello Everyone,

I'll be cyber-challenged for the next week or so while traveling. Consequently I won't be reading or responding to questions until I return. Don't despair! Please remember, if you have a question, search the archives! The chances are excellent that you will find the information or reassurance you are seeking is there waiting for your double click.

Below, I'm also appending the transcript of my recent "live chat" on The Body. Several questioners have asked that I reprint it here in the forum. And, as always, your wishes are my commands!

Be well. Stay well. Remember to vote Democrat. Isn't it amazing that things are getting so calamitous for the GOP that even Dubya is distancing himself from Dubya? As Maureen Dowd noted, "The President is cutting and running from the President!" No more stay the course! Hmmm . . . course??? What course????

Gosh, what a bunch of dodo birds! Is it 2008 yet?

Ciao,

Dr. Bob

Transcript of The Body's Live Chat on Fatigue and Anemia With Dr. Bob Frascino

September 27, 2006

Following is the transcript of The Body's live chat on fatigue and anemia, which took place on Sept. 27, 2006, at 6 p.m. Eastern Time. The chat was sponsored by Gilead Sciences, moderated by The Body's editorial staff and hosted by Dr. Bob Frascino. This transcript has been edited for grammar and clarity. This is the eighth chat that The Body has moderated; to see transcripts of previous chats, click here.

Moderator: Thanks, everybody, for coming to our live chat on fatigue and anemia! Our speaker for today's chat is Dr. Bob Frascino, one of the most popular doctors in our "Ask the Experts" forums and an authority on fatigue-related problems in HIVers. Dr. Bob, before we begin answering everyone's questions, is there anything you'd like to say?

Dr. Robert Frascino: Hey there boys and girls. Welcome to the cross-dressing, Republican lesbian Mormon midget, casual-sex hook-up chat room. ... Oops. Sorry. Wrong chat. Let's see now. ... Wednesday, Sept. 27? Oh yes, here we go. Distinguished guests, welcome to The Body's live chat on HIV-related fatigue and anemia. Dr. Bob here, in the cyber-flesh. Chances are most of you already know me. Otherwise you'd be spending your Wednesday evening doing something more productive, like watching "Seinfeld" reruns or sitting in your parked car with sunglasses on and pointing a hairdryer at passing cars to see if they slow down. For those of you who don't know me, I'm an HIV/AIDS specialist physician with a quarter of a century of experience in the field of HIV/AIDS medicine. I became HIV positive in January 1991 following an occupational exposure while treating a patient with advanced-stage HIV disease.

I am president and founder of The Robert James Frascino AIDS Foundation, which to date has raised well over $1 million to help fulfill our mission (1) to provide crucial patient services for men, women and children living with HIV/AIDS worldwide and (2) to raise awareness of the AIDS pandemic through education and advocacy. (You can learn more about the foundation on our Web site, www.concertedeffort.org.)

In addition, I am the founder of two medical clinics devoted to the comprehensive and compassionate care of people living with HIV/AIDS. As an investigator in several HIV clinical trials, I have published medical journal articles on evolving new treatments and quality-of-life issues for people living with HIV/AIDS.

I reside in the San Francisco Bay Area with my life partner Steve (Dr. Steve Natterstad, an expert in The Body's "Tratamientos" forum) and our pooch Presto! I'm a five-foot-eight-inch, salt-and-pepper haired, hazel-eyed, 29-inch waisted, lean-muscled, gym-buffed Italian with ... oops -- TMI (Too Much Information)! OK, let's get this party started! Crank up the volume, Moderator. Let the games begin! Chatter up! (So to speak.)

Moderator: Thanks, Dr. Bob, for that extremely succinct intro. With that, let's open up the floor to your questions!

Question from crf: Is there any way to determine the source of fatigue (HIV, meds, etc.) if one's diet and testosterone levels are normal?

Answer from Dr. Robert Frascino: An easy way to determine the source of fatigue? Well, sometimes yes, but not often. If you just participated in a triathlon, sure, it's easy to know why you're worn out. However, if you're just an HIV patient who is fatigued, there are numerous possible causes. Worse yet, HIV-associated fatigue is often multifactorial. That means several underlying problems may be working in tandem to drain your energy. During the chat, we'll be touching on lots of underlying conditions that can potentially contribute to HIV-related fatigue. The most important thing to remember is that you'll need to work closely with your HIV specialist to identify all the underlying conditions and then treat each one specifically. Let me proceed to the next questions and I'll add details about HIV-related fatigue diagnoses as we proceed, OK?

Question from anonymous: I was infected around December 2004 or January 2005. My last counts [showed a viral load of 84,000 and a CD4 count of 590]. I followed up on my health while I lived in [one] European country, but now that I have moved to another European country, I can't get myself health coverage yet, so I'm not following up at all. Lately I've been feeling fatigued and having a mild headache most of the day. What do you think I can do to manage this fatigue? I can't follow up on my health anytime soon -- probably not for another six months or so. Kudos for your exceptional humor, doctor -- I think a Dr. Bob TV show on Comedy Central is your next step after quitting that tiring job of yours.

Answer from Dr. Robert Frascino: Hi. HIV-associated fatigue is astoundingly common! How common? Glad you asked! (Even if you really didn't.) The results of two epidemiological studies revealed that, among those of us who are "virally enhanced," 54 percent and 67 percent reported fatigue as a symptom at some point during the course of their illness. And you can certainly count me in as one of those who doesn't like having his "strive-to-thrive spirit" messed with! So what can you do about your power drain? Simplistically speaking, you identify the cause and treat it. The unfortunate reality is that it's not as easy as sipping a teaspoon of Lucy's Vitameatavegamin [of the television series "I Love Lucy"]. Why? Well, as it turns out, there are numerous possible causes of fatigue among persons with HIV infection. Often a person with fatigue has several problems that can interact to zap their zip. Fatigue can be caused by inappropriate attention to basic human requirements such as rest, diet and exercise. Anxiety and depression are associated with fatigue. It can also be a symptom of an opportunistic infection, hormonal imbalance or anemia. Add in drug side effects and toxicities and you can see this list of common underlying causes is already getting lengthy. I suggest you check the archives of The Body's experts forum on fatigue and anemia. There you can find information on all the common and many not-so-common causes of HIV-associated fatigue.

Mild headache? That also can be caused by a wide range of underlying problems, from chronic sinus congestion to needing glasses to listening to Dubya [U.S. President George W. Bush] and Cheney [U.S. Vice President Dick Cheney] babble on about how wonderfully things are going in Iraq. (Actually, that last one gives me migraines.) I can't diagnose the exact cause of your problem over the Internet.

Now what's this nonsense about not getting medical follow-up for the next six months? Even if you don't have health insurance in place, you shouldn't short change your health care. Pull out your credit card if necessary, but I urge you to establish care with an HIV specialist now. Assuming your physical examination checks out and your symptoms are stable, you can, for now, forgo the expensive CD4 counts and viral load tests if necessary, but being under the watchful, wise eye of a competent HIV specialist is, in my opinion, essential. The specialist will also help you identify the cause of your fatigue and headaches and institute specific treatment for the underlying problem.

Finally, if I quit my "tiring job" as expert on The Body's "Safe Sex and HIV Prevention" forum and "Fatigue and Anemia" forum, I would worry about the [fallout] from the "worried wells" who often frequent the forums. One recently told me that if I left, there would be more tears than when Diana [Ross] left The Supremes. Consequently, I can't leave or folks might get dehydrated. Besides, I think Jon Stewart and Stephen Colbert are doing a fine job keeping us informed and entertained on Comedy Central. Stay well.

Question from FrauG: Does anemia develop gradually while one is on meds, or can it happen quickly?

Answer from Dr. Robert Frascino: Anemia can indeed happen relatively quickly. For instance, if you met Count Dracula or Freddy Krueger in a dark alley, well, you could become anemic within moments. Kidding aside, HIV-associated anemia related to medications can occur relatively quickly. For instance, anemia induced by AZT [brand name: Retrovir; also known generically as zidovudine] can show up within days to weeks.

Other causes of HIV-associated anemia, like anemia of chronic disease (caused by HIV itself) can take years to evolve.

OK, next question! Wowza! You guys have lots of questions. I'm getting fatigued just perusing all of them. OK, let's try this. Anyone who didn't vote for Bush and Cheney [in the U.S. Presidential elections of 2000 and 2004] step to the head of the line. Apparently that's all of you. OK, then onward we go. Looks like I'll have to type faster!

Question from anonymous: I am an HIV-positive, 43-year-old, Hispanic male. I have been diagnosed with HIV for over 21 years. Recently, I have been diagnosed with stage 5 kidney disease. I may be undergoing dialysis within the year or next year. I am really hoping not to and am holding off. My question is that I've been taking Epogen [generic names: epoetin alfa, erythropoietin] shots for the last couple of months. I inject 1 mL every week. Is there a long-term effect from taking Epogen? Why do I feel tired even when I do get the Epogen injection? Also, which medication is causing my fatigue and anemia? I'm on Epivir [generic name: lamivudine; also known as 3TC], Retrovir and Reyataz [generic name: atazanavir; also known as ATV]. Thank you -- Rivy.

Answer from Dr. Robert Frascino: Hello, Rivy. There are no long-term consequences from taking epoetin alfa injections. This is a medication to stimulate the production of new red blood cells from the "red blood cell factories" in your bone marrow.

There are many potential causes for your HIV-related fatigue. These are discussed in detail in the archives of The Body's "Fatigue and Anemia" forum. Of the potential medication-related causes, Retrovir would be the prime suspect. That medication can suppress bone marrow function, thereby suppressing red blood cell production and thereby causing anemia. In fact, there are many potential causes that could be contributing to your anemia, including: anemia of chronic disease (related to your 21-year, HIV-positive status), kidney disease and, as mentioned above, use of Retrovir.

I would suggest you do two things: First, talk to your HIV specialist about your fatigue. Work cooperatively with him to identify all the potential underlying causes and make a plan to treat each of these specifically. You should also check to see how well your current dose of Epogen is working to treat your anemia. The normal range of hemoglobin for men is 14 to 18 g/dL. Your Epogen dose may need to be adjusted or you might need iron supplementation so that the Epogen can have its maximum desired effect in helping to correct your anemia. Second, review the archives of The Body's experts forums to learn more about HIV-associated fatigue, HIV-associated anemia, HIV medication side effects and epoetin alfa therapy. Good luck, Rivy! You can contact me at the "Fatigue and Anemia" forum if you need me, OK?

Moderator: The Body's "Ask the Experts" forums are live at: www.thebody.com/experts.html.

Question from anonymous: If your testosterone level is fine, your thyroid is fine and you are not anemic, what do you check next?

Answer from Dr. Robert Frascino: OK, you've ruled out exactly two of the 5,896 common causes of fatigue. After testosterone and thyroid, you should check for anemia, inappropriate attention to diet, rest, sleep, medication side effects, unrecognized infections, other hormonal problems (adrenal insufficiency), psychological problems and the realization that 2008 is still a long way off. All of these things can zap your zip! Next chatter up! We're on a roll now.

Question from anonymous: Do you think fatigue and anemia affect men or women more? Or does it make no difference? I know that the normal hemoglobin range for women is lower than for men, for instance. Does this mean it's easier for men to become anemic or does it mean it's worse for women because they have less to start with? Do you have any personal experience with whether, generally speaking, men or women are better equipped physiologically to cope with HIV? Or is it an equal opportunity disease?

Answer from Dr. Robert Frascino: Republicans are more fatiguing than Democrats, but HIV-associated fatigue is an equal opportunity annoyer.

Regarding HIV-associated anemia, in the era of HAART (highly active antiretroviral therapy), there is greater prevalence of anemia in women and African Americans [than in other demographic groups].

As for it being easier for one sex to become anemic -- no. It's how far the hemoglobin falls from the normal baseline that causes the problem.

[Are] men or women better equipped to cope with HIV? Women, of course. They handle everything better. Can you imagine Dick Cheney or Rummy [U.S. Secretary of Defense Donald Rumsfeld] going through childbirth?

Question from tlthom910: So often there's much that a poz individual has little or no control over ... what is it about fatigue that we can control?

Answer from Dr. Robert Frascino: How much coffee you drink and how aggressively you work to determine all the various causes of your fatigue. Next question!

Question from anonymous: Are there any herbal supplements, vitamins or protein stuff used by body builders that you can recommend? I am trying to avoid any form of prescription medication to deal with fatigue and want to avoid possible drug interactions.

Answer from Dr. Robert Frascino: Hi. The best way to treat any symptom is to find out what's causing it and then treat the underlying cause. So, if you're ass-draggin' because your diet consists only of Big Macs, super-sized fries, chocolate shakes and Snickers bars for dessert or, on the other end of the spectrum, because you're a pesco-ovo-lacto-vegan who only eats organic grass and drinks purified water, well then your diet could be a cause of your fatigue. An HIV-knowledgeable nutritionist can check the adequacy of your diet and recommend supplements if necessary. However, in general, body builder "herbal supplements, vitamins and protein stuff" are not the way to go to address HIV-related fatigue or, I might add, to avoid "possible interactions" either.

I suggest you peruse the wealth of information in The Body's "Fatigue and Anemia" experts forum archives. Make a list of potential causes of HIV-associated fatigue and then discuss this with your HIV physician. HIV-associated fatigue isn't like strep throat. It's often not all that easy to identify the underlying cause or causes. However, with some collaborative detective work, you and your HIV specialist should be able to figure out exactly what's wrong and how to make it right again. Finally, remember that gym-bunny, muscle studs aren't exactly known for their intellectual prowess, so to speak. Their raison d'etre is to look better naked at any cost, not to be energized and optimally healthy. (Otherwise they wouldn't be injecting growth hormone and anabolic steroids and gulping down mega-doses of vitamins, despite health warnings cautioning against such interventions.)

Good luck! Hope your batteries are recharged soon.

Question from L.B.: Dr. Bob: I've been positive for 21 years and I'm struggling with fatigue. I've tried exercising with a tread mill, but the neuropathy in my feet and legs makes this difficult. I'm also being treated (Wellbutrin [generic name: bupropion]) for depression. My question: What low impact exercise do you recommend that might best help with fatigue?

Answer from Dr. Robert Frascino: Swimming and sex. Not necessarily in that order.

Question from Rex: Should I have less fatigue with Atripla [generic name: efavirenz/tenofovir/FTC] than Sustiva [generic name: efavirenz; also known by the brand name Stocrin] and Combivir [generic name: zidovudine/lamivudine; also known as AZT/3TC]. Thanks -- Rex.

Answer from Dr. Robert Frascino: Hey Rex. Maybe! For instance, it's possible that the AZT in your Combivir could have been causing some anemia, which could in turn cause fatigue. Overall, we've had good luck with Atripla if folks don't mind the weird dreams associated with Sustiva. Personally, I loved them.

Question from anonymous: Because I get so tired and sometimes have to take three- to five-hour naps in the afternoon, it disrupts my sleep schedule through the night. Despite a dependence on sleeping pills, which does not work, what can I do to keep a normal sleeping pattern?

Answer from Dr. Robert Frascino: Hi. Five-hour naps in the afternoon? Wow, does the afternoon even last five hours? That's even longer than Dubya's post-lunch siestas. Of course Dubya really views consciousness as that annoying time between naps (when he tends to muck up the world order). But I digress ...

It sounds like you need to re-regulate your sleep cycle. This can be done gradually by shortening your afternoon siestas (use an alarm clock if necessary) plus by using a mild, long-acting sleep aid for a short duration of time (several weeks) until your sleep cycle normalizes again. You'll also need to evaluate what's disturbing your nocturnal rest. Exercise late in the day? Caffeine? Medication side effects? (Sustiva is a prime example.) Your pet cat jumping on your head every two hours? Sex-crazed neighbors doing a noisy mattress mambo? Whatever. Your HIV specialist or general medical doctor can review your daily habits, diet, exercise routine, anxiety/stress levels, etc. and make specific recommendations so you can get back to your restful z's. Pleasant dreams.

Question from anonymous: I was diagnosed in February 2006 after a bout of PCP [pneumocystis carinii pneumonia] and a lot of weight loss. I spent three weeks in the hospital. My CD4 count was 114 and my viral load was 100,000. I was anemic and had been fighting fatigue for many months, not knowing what was going on -- it was winter, so I just took it for the usual winter misery in England. I have been on meds now for five months and I feel a lot better, only getting oral thrush. I have stopped menstruating and my anemia has now disappeared. I am concerned that when I start menstruating again I will become anemic again. I have always been healthy, eaten right, [had a] good home life and [done] yoga. (I'm married.) I am in a demanding job where I have to be active (area manager). Is there anything I can do to prevent the anemia from reoccurring? I am on saquinavir [brand names: Fortovase, Invirase], ritonavir [brand name: Norvir; also known as RTV] and Truvada [generic name: tenofovir/FTC]. My blood [tests] in early August [showed a CD4 count of] 391 [and a viral load of] 198, which I am over the moon about. I love you and all you stand for. Thank you.

Answer from Dr. Robert Frascino: Hi. Are your menstrual cycles abnormally heavy? If so, you may need to check in with your gynecologist. Generally speaking, menstrual cycles should not produce significant anemia. Perhaps you have more than one cause for your anemia. Check with your HIV specialist. Your current HIV meds should not be a problem.

Moderator: While you're waiting for Dr. Bob's next answer, we hope you'll consider donating to the Robert James Frascino AIDS Foundation, which Dr. Bob has founded. To learn more about his foundation, open up a new browser window and go to www.concertedeffort.org.

Dr. Robert Frascino: There are lots of other potential contributing factors for anemia -- inadequate amounts of nutrients (iron, vitamin B12 and folic acid), insufficient production of certain hormones, complications of HIV infection and even HIV itself.

Question from anonymous: Exhausted, just normally tired or anemic? Which am I, Dr. McDreamy?

Answer from Dr. Robert Frascino: Hello. I really don't know. Am I supposed to guess or perhaps, instead of this forum, you were trying to reach the psychic hotline?

Regarding anemia, the diagnosis is really quite simple. A simple blood test called hemoglobin will give you the answer. If your hemoglobin level is less than the lower limit of normal, you're anemic. For men, the lower limit is 14 g/dL (12 g/dL for women). So just take a look at your blood test results and you can tell if you're anemic or not.

Now regarding tired versus exhausted, I'll once again quote an old Chinese proverb. Confucius say: Man who run behind car get exhausted, but man who run in front of car get tired.

Question from johnnycoyote: Hi, Robert: I've been on a regimen of Zerit [generic name: stavudine; also known as d4T], Videx [generic name: didanosine; also known as ddI] and Epivir since the beginning of my treatment 10 years ago. At the beginning of this year, I changed to Viread [generic name: tenofovir; also known as TDF] and Kivexa [generic name: abacavir/3TC; also known by the brand name Epzicom]. Everything's fine, results are great and I'm gaining some facial weight again, but I've been experiencing a little fatigue and a lower sex drive, so my doctor just prescribed Androtardyl [generic name: testosterone enanthate] injections twice a month. Could you tell me a little more about the effects and possible side effects please? By the way, you have been quite an inspiration for me over here in Paris, France. Thanks.

Answer from Dr. Robert Frascino: Hello, Paris. One of my very favorite destinations in the world!

Androtardyl is an androgenic steroid used to treat hypogonadism (low testosterone level). It can perk up men's moods, nutrient metabolism, sexual function and energy levels. (It also perks up Mr. Happy [the penis].)

Adverse side effects include pain upon intramuscular administration, hirsutism [excessive hair growth] and virilization [taking on masculine characteristics] (in women), priapism (Mr. Happy being too happy for too long), acne, premature epiphyseal closure [premature fusion of the parts of the long bones] in kids, increased serum triglycerides and some liver problems.

Therefore this can be great stuff, but should only be used if there is clinical justification to do so! Please send my best to the guys at Open Café in the Marais, OK? À bientôt [see you soon].

Question from anonymous: I am 60 years old and have been HIV positive for about 25 years, also diagnosed with hepatitis C in advanced stage three years ago. (No needles though.) I feel fortunate that I have not been hit with any major opportunistic infections other than neuropathy in my feet. But now I'm on a new drug regimen (out of necessity): Prezista [generic name: darunavir; also known as TMC114], Truvada, Norvir and Fuzeon [generic name: enfuvirtide; also known as T-20]. My T cells are holding around 330 and my viral load is 211, up from less than 50. I am experiencing daily fatigue around 3 p.m. (nap time comes early). This is not good, because I am self employed, working full time. Usually an hour or so of downtime keeps me up for another four to five hours. I have nixed antidepressants this time, but used them for severe depression several years ago with great results. I don't feel bad, just very tired and lethargic. Every day. Got any ideas? Thanks, from Houston man.

Answer from Dr. Robert Frascino: Hello, Houston Man. You've been positive for 25 years? Wow! The pandemic is only 25 years old. Talk about getting in on the ground floor! Added to that, you were diagnosed with hepatitis C (advanced stage) three years ago! OK, so let's talk about your fatigue!

In the immortal words of Joni Mitchell, "Don't it always seem to go, you don't know what you got till it's gone?" She may not have been singing about HIV-related fatigue, but it certainly seems applicable to me! Did you know that fatigue is the most common complaint of those of us who are "virally enhanced"? You have double trouble -- not just one chronic viral infection (HIV), but two (HIV and hepatitis C). This can be a double whammy on your strive-and-thrive get-up-and-go.

First off, I'd suggest you review the archives of The Body's "Fatigue and Anemia" experts forum. I have written extensively on a variety of common causes that could be contributing to your HIV-related fatigue. As it turns out, fatigue, in the setting of HIV (and hepatitis C, too) is often a multifactorial problem. That means there are often multiple causes working simultaneously to make you feel wiped out. Your first step is to talk with your HIV specialist and review the potential causes of your fatigue, including: anemia; inappropriate attention to diet, rest and sleep; medication side effects; unrecognized infections; hormonal problems; psychological problems; and HIV itself.

You report you "nixed antidepressants this time, but used them for severe depression several years ago with great results." Why nix them this time? Depression can cause significant fatigue and lethargy, even though you don't feel as "bad" as you did when you used antidepressants previously. To regain your energy, you need to specifically treat all the various components that may be contributing to your problem. An evaluation by an HIV-knowledgeable psychiatrist might help in determining whether your depression is resurfacing again.

As I mentioned above, you can read my comments about a variety of potential causes in the archives. In addition, you'll need to check with your physician about your hepatitis C to see how sick your liver is. A biopsy can gauge the degree of scarring and guide treatment. The best treatment for hepatitis C is pegylated interferon [brand names: Pegasys, Peginterferon, PEG-Intron] plus ribavirin [brand names: Copegus, Rebetol, Virazole]. Interferon [brand names: Roferon-A, Intron A, Alferon N] can cause side effects, such as depression and "the flu from hell." Ribavirin often causes anemia. Anemia is often associated with fatigue. On the upside is the fact that the liver is an awesome regenerator, but you'll need to treat it right. That means no booze, heroin or other substance abuse that might further damage it.

In your particular case of significant fatigue in the setting of HIV and hepatitis C coinfection, I would be particularly concerned about anemia. Check your hemoglobin level. If you are below the lower limit of normal (14 g/dL for men), then work with your doctors to find out why. Is it the ribavirin used to treat hepatitis C, HIV itself, nutritional deficiencies, etc.? Treatment of the anemia will depend on the cause. Iron supplementation for iron deficiency anemia, for instance. Or Procrit for drug-induced anemia (perhaps due to ribavirin) or anemia of chronic disease (HIV itself). Procrit is a medication that stimulates the body to make additional new red blood cells, thereby improving anemia-associated fatigue.

So, in the words of another immortal entertainer (Lucille Ball), you want to be one of "those happy peppy people who don't pop out at parties." To do so, you'll need to be aggressive at chopping away (i.e., evaluating and treating) all the things that are causing your fatigue. How aggressive do you need to be? Well, that leads me to my last immortal quote (Mommie Dearest): "Tina, bring me the ax!"

Good luck. Gosh, I've just used quotes from Joni Mitchell, Joan Crawford and Lucille Ball all in the same response.

Moderator: I'm afraid we only have time to answer one more question; sorry to all of you who have submitted questions that we couldn't get to today! We hope you'll use TheBody.com's "Ask the Experts" area at to get the answers to your questions. (Dr. Bob regularly answers questions in both our "Fatigue and Anemia" forum and our "Safe Sex and HIV Prevention" forum.)

Question from latingalnc: I was just recently diagnosed with HIV. I have been started on Sustiva and Truvada. I also have fibromyalgia. How do I know [if my fatigue is due to] the HIV meds or my fibro? What can I do about it!? I am an African-American woman in my 40s.

Answer from Dr. Robert Frascino: Hi. Tough question. This would take some collaborative detective work between you and your HIV specialist and fibromyalgia doctor. I would suggest you review all the potential causes of HIV-associated fatigue that I discuss in the archives of The Body's "Fatigue and Anemia" experts forum and then discuss those with your HIV doctor. For instance, could the Sustiva be interrupting your sleep with weird dreams, like dreaming you were married to Cheney? (Insert total body shiver here.)

You'll also need to optimize treatment for your fibromyalgia. Once you've done all the diagnostic evaluation and maximized your treatment, if you're still tired, I suggest a stiff double espresso on an as-needed basis and also realize that HIV "mystery fatigue" does exist -- even when we fight back with body, mind and soul!

We certainly need to fight with all three and realize we are living with a really nasty virus. But the key word is living! So even if we get pooped out from time to time, let's all be here for the cure, OK? One buddy just told me: "I plan to live forever. So far, so good." Hey everybody, thanks for tuning in! I hope you learned something along the way. I sure did. I learned I'm a shit typist. Thanks for your patience. (No use being a doctor, if there aren't any "patients.") Ciao. Be well. Stay well.

Moderator: Well said, Dr. Bob. With that, our interactive chat on fatigue and anemia is now over. Dr. Bob, thanks so much for taking the time to answer everyone's questions!

To all of you who asked questions or took the time to join our chat tonight: Thank you for spending the past hour with us! A full transcript of this chat will be available on TheBody.com within the next week. As soon as it's up, we'll provide a link to the transcript within our weekly e-mail newsletter, which you can sign up for at: www.thebody.com/subscribe/joinbody.html.

To those of you whose questions we were unable to answer tonight: Please try visiting TheBody.com's fatigue page (at www.thebody.com/treat/fatigue.html) or our anemia page (www.thebody.com/treat/anemia.html) for more information. You can also ask Dr. Bob a question at his "Ask the Experts" forum on "Fatigue and Anemia," which you can visit at: www.thebody.com/Forums/AIDS/Fatigue/.

Thank you all, again. Have a good night!

Copyright © 2006 Body Health Resources Corporation. All rights reserved.


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