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Fatigue and AnemiaFatigue and Anemia
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Aug 12, 2001

Dear Dr. Bob,

Thanks again for all you do. You have mentioned in your responses that one should be checked for adrenal deficiencies as a possible cause of anemia. What test would I ask my doctor to request in order to check for this? Also, what is your definition of an HIV Specialist?

Response from Dr. Frascino


I think you may have misread my reply on adrenal insufficiency. It's a potential cause of fatigue, not anemia. The adrenal glands are located on top of the kidneys. They are responsible for producing many essential hormones that regulate how the body functions. Adrenal insufficiency is the inadequate production of adrenal hormones. It can be caused by certain anti-HIV drugs, HIV infection itself, or by opportunistic infections including CMV (cytomegalovirus) and TB (tuberculosis), which can directly infect and damage the adrenal glands. Adrenal insufficiency can results in fatigue, chronic weight loss, decreased blood pressure, dizziness, and ultimately, death. The diagnostic tests for this condition include morning and evening plasma cortisol levels (morning level less the 275 umol/L in most labs is suggestive of adrenal insufficiency), single-dose cosyntropin stimulation test, and plasma ACTH levels.

The definition of an HIV specialist? That's actually quite a difficult question to answer. Presently, we do not have a specialized training program specifically in HIV Medicine. I personally was trained in Pediatrics and then Immunology/Allergy. Other specialists may have general internal medicine or infectious diseases backgrounds. There are several groups trying to formalize a definition for an "HIV specialist," including The American Academy of HIV Medicine, a relatively new organization. You might want to visit their website at for additional information. For the present time, perhaps the best definition of an HIV specialist is the physician in your area with the most expertise in competently and compassionately treating people with the virus. Local AIDS service organizations can often help locate HIV-knowledgeable physicians in your area.

Best of luck,

Dr. Bob

Neuropathy and fatigue
All of a sudden, fatigue has set in.

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