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Fatigue and AnemiaFatigue and Anemia
           
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fatique, even with good t cells and viral load
Aug 18, 1998

hi, i read your questions on a regualr basis and find it great. my question is about my fatique, i have a t cell of 800 undetected viral load for 2 yrs and been pos. since 1994 sept when i caught it. i have had every test run and everything comes back normal including testosterone, b12 folic acid, thyroid even though i use to take synthroid a few years back for 7 yrs and then took me off it because it was suppose to be fine. i'm not working because of the fatique and don't sleep well at all. i take trazadone 50mg up to 6 at bed time plus 5mg buspars 2 at bed time and still don't sleep i am taking them for sleep and depression. also i take combivir and fortovase since day one and doing well on them and i am also on the remune vaccine trial you no the salk vaccine. do you have any comments on what i can do for the fatique and sleep problems. i started taking melatonin and it seems to help i even started to cut back on the trazadone and buspar with the melatonin and seem to sleep better that way. also what dose is the best for melatonin i take 3mg at bedtime help please thanks a million.

Response from Mr. Molaghan

Hello Thanks for providing such a detailed history. You've covered most of the important areas in evaluating fatigue and HIV disease; however, I'd like to comment on a few points. Did you experience this level of fatigue prior to testing positive for HIV? This is important to determine. You've mentioned several test results that were normal. Was your hemoglobin level normal? As you know, Combivir contains AZT (Retrovir), which can cause anemia as a side effect, and subsequently cause fatigue. If your hemoglobin level is low, you might want to discuss this with your physician. Treating depression can be challenging when trying to find the right medication. Trazadone and Buspar can have sedating side effects such as a "hangover" type feeling during the day. The fact that you're experiencing better sleep by cutting back on the Trazadone and Buspar while using melatonin, seems to support this. The FDA does not classify melatonin as a drug; it's considered a nutritional supplement, therefore, rigid clinical trials and dosing recommendations are not required. The recommended doses are determined by the manufacturer, and not determined by the FDA. Insomnia is always a difficult symptom to treat. Some very basic additions that might help you sleep include a daily exercise regimen. It doesn't have to be rigid, and should be avoided too close to bedtime. Also, chamomile tea at bedtime has a relaxing effect on many people. I'm also curious about why the synthroid was discontinued. Were thyroid function tests performed? Discuss some of these issues with your physician and/or psychiatrist to determine if some of the medications might be contributing to your fatigue. Good luck! Keep us informed.


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