Hello Dr. Holodniy,

I am a 30 year-old man recently diagnosed with HIV. I am not at the point where I have to be on medication (CD4 650). I do not smoke or do any other drugs, have always eaten nutritious food, and am quite fit and lean. Looking back at the past couple of years (throughout which I must have been infected), I can recall occasional bouts of fatigue in the middle of the day. I tend to brush them off, thinking they may be due to the fact that I slept late, or slept too much, or have just eaten. A cup of coffee usually helps, as does even the most intensive of workouts in the gym! My question is: from your experience, do patients with HIV whose immune system is still doing a good job on its own complain about having fatigue? I'm new to all of this, but I can already tell that my HIV specialist has a tendency not to attribute ANYTHING to HIV at this stage. To me, it seems almost obvious that if my body is constantly fighting a replicating virus, there should be consequences in the way I feel on the day-to-day basis. Again, I can usually deal with the fatigue at this point, and I mostly find myself positively surprised when, at midnight, I still feel full of energy despite my afternoon's lethargy. I fear, though, that it might worsen. In that case, would taking medication before CD4 reaches 350 be advisable, so as to make the virus undetectable and so less potent in my body? Thank you very much.

You don' indicate what your viral load is. Some people with normal CD4 counts but very high HIV viral loads do complain about fatigue. Other medical conditions need to be thought about and ruled out before attributing this to HIV infection. Things like low thyroid, depression, HCV co-infection among others can be contributing to the fatigue.