Clinical Guide > Common Complaints > Fatigue


January 2011

Chapter Contents


Fatigue is one of the most common and debilitating complaints of HIV-infected people, with an estimated prevalence of 20-69%. It is defined by Aaronson et al. as "a decreased capacity for physical and/or mental activity due to an imbalance in the availability, utilization, and/or restoration of resources needed to perform activity." The consequences of severe fatigue may include curtailment of work and other activities, need for frequent breaks, limitations in involvement with family and friends, and difficulty completing even the simplest household chores.

In HIV-infected individuals, fatigue may be caused by several comorbid conditions or by HIV itself. HIV-related fatigue is a broad term referring to fatigue that begins or significantly worsens after the patient is infected with HIV and that has no other identifiable causes. HIV-infected people with fatigue should be evaluated carefully for reversible causes, such as depression, anemia, hypogonadism, insomnia, and medication adverse effects, and should be treated aggressively if these are found. In some patients, fatigue may be related to advanced immunosuppression (with low CD4 cell counts) or to high levels of circulating HIV virus. Unfortunately, for many patients, a specific cause of fatigue is not identified. Research to date suggests that fatigue in many HIV-infected individuals may result from a complex interplay between physiologic and psychosocial variables, and studies are being conducted to define factors related to the onset or worsening of fatigue.

S: Subjective

The patient complains of tiredness, easy fatigability, a lack of energy, a need for frequent rest or naps, or waking in the morning feeling unrefreshed. The patient may report difficulty working, difficulty concentrating, inability to exercise without experiencing profound fatigue, or impairment in social relations because of fatigue.

Consider the following during the history:

O: Objective

Check vital signs and orthostatic blood pressure and heart rate measurements, if indicated. Perform a physical examination including evaluation of nutritional status, affect, conjunctivae and skin (for pallor), thyroid, lungs and heart, and deep tendon reflexes.

A: Assessment

The differential diagnosis includes the following:

P: Plan

Diagnostic Evaluation

To rule out reversible causes of fatigue, perform laboratory tests, including:

Fatigue assessment tools, as mentioned above, may be used to assess the intensity of fatigue, the circumstances surrounding fatigue, and the consequences of fatigue.


If testing reveals a specific cause of fatigue, treat appropriately. For example:

After appropriate evaluation, if the fatigue is thought to be related to HIV infection or if no specific cause is identified, consider the following:

Patient Education