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Fatigue and AnemiaFatigue and Anemia
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Fatigue: Drug change?
Aug 19, 2001

I have terrible hiv related fatigue and my Doc has done all the tests and apparently they are not showing anything abnormal. A friend of mine was on the same meds as me (Combivir and Indinavir) and had the same problem with fatigue. He substituted one of these drugs with Kaletra and does not feel fatigued any more. Should I ask my GP to do the same for me? I am diagnosed 6 months CD4 is 300, VL is 500 Thanks Dr Frascino

Response from Dr. Frascino


You are not alone! HIV fatigue is our most common complaint. Unfortunately, the cause or causes for that fatigue vary greatly from person to person. Your friend's fatigue was improved by switching medications and that's very good news, but don't count on your condition responding the same way. It may not.

As I have mentioned before, the cause of HIV-related fatigue is often multifactorial with numerous conditions contributing to the problem. Fatigue can be caused by inappropriate attention to basic human requirements such as rest, diet, and exercise. Psychological causes include stress, anxiety, and depression. Fatigue can be a symptom of an opportunistic illness or caused by abnormalities of the endocrine system - low testosterone in men, adrenal insufficiency, and low production of thyroid hormone. Fatigue may be due to drug side effects, and even HIV itself. Finally, fatigue can be caused by anemia, a very common disorder associated with HIV infection and its treatment. You are on Combivir, which contains AZT. AZT is well known to suppress the bone marrow and decrease the production of blood cells. Check with your HIV specialist again and review the common causes I mentioned above. Get copies of your lab work and see if your values are really in the normal range, particularly your hemoglobin. The lower limit of normal for men is 14 g/dL and for women, 12 g/dL. You should also talk with your HIV specialist to see if there is a way to get your viral load down below the level of detection. The bottom line is that you should not settle for having "terrible" fatigue. Find the cause or causes and treat the underlying problem. For instance, if you are anemic, Procrit may be very helpful for you. It stimulates your bone marrow to make new red blood cells.

Good luck, write back if you're still having problems.


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