Physiological and Psychological Correlates of Fatigue in HIV Disease

Abstract

Fatigue is a frequent symptom reported by persons living with HIV disease and one that affects all aspects of quality of life. To improve quality of care of persons with HIV disease, it is important to address all factors that contribute to fatigue. The purpose of this study was to determine the associations of physiological, psychological, and sociological factors with fatigue in an HIV-infected population. With Piper's integrated fatigue model guiding selection, factors examined in this study were hemoglobin, hematocrit, CD4+ cell count, HIV-RNA viral load, total sleep time, sleep quality, daytime sleepiness, HIV-related symptoms, anxiety, depression, and perceived stress. The sample (N = 79) for this descriptive correlational study was recruited from a primary health care association in South Carolina and consisted of 42 (53.2%) HIV-infected women and 37 (46.8%) HIV-infected men between the ages of 24 and 63 years (x = 39.9, s = 7.9). Of the participants, 70 (90%) were African American, 5 (6%) were Caucasian, and 3 (4%) were Hispanic. Using Pearson's r, significant relationships were observed between fatigue and sleep quality, daytime sleepiness, HIV-related symptoms, state anxiety, trait anxiety, depression, and perceived stress. Sleep quality (F5,65 = 12.02, P = 0.0009), state anxiety (F5,65 = 8.28, P = 0.0054), HIV-related symptoms (F5,65 = 4.87, P = 0.0308), and depression (F5,65 = 7.31, P = 0.0087) retained significance in a 3-step, backward stepwise elimination model and accounted for 67% of the variance in fatigue. These findings underscore the need for addressing psychosocial stressors and sleep quality in developing effective care for HIV-infected individuals who experience fatigue.

Sleep Apnea Symptoms as a Predictor of Fatigue in an Urban HIV Clinic

“…81% were on ART with a mean current CD4 cell count of 579 -284 cells/mm 3 . The majority of the patients (81%) had undetectable viral load; 52 (27%) participants reported loud snoring, and 47 (24%) reported witnessed apneas.…”

“…F atigue is one of the most common self-reported and provider-identified symptoms in persons living with HIV/AIDS (PLWH) 1 with a prevalence ranging from 60% in HIV infection 2,3 to 85% among those with AIDS. 3 Several predictors of fatigue are common in this population, including systemic inflammation, anxiety, depression, chronic pain, aging, medical co-morbidities, and sleep disturbances.…”

“…3 Several predictors of fatigue are common in this population, including systemic inflammation, anxiety, depression, chronic pain, aging, medical co-morbidities, and sleep disturbances. [3][4][5][6][7] Antriretroviral treatment (ART) medications themselves may induce fatigue, although data from the era prior to effective ART and the modern ART era show a similarly high prevalence of fatigue, and a large cohort study showed no overall relationship between ART use and fatigue. 8 The sleep disturbances studied to date, and associated with fatigue in PLWH, 3,9 have included insomnia, poor selfreported sleep quality, and increased sleep fragmentation.…”

“…[3][4][5][6][7] Antriretroviral treatment (ART) medications themselves may induce fatigue, although data from the era prior to effective ART and the modern ART era show a similarly high prevalence of fatigue, and a large cohort study showed no overall relationship between ART use and fatigue. 8 The sleep disturbances studied to date, and associated with fatigue in PLWH, 3,9 have included insomnia, poor selfreported sleep quality, and increased sleep fragmentation. 10 Fatigue and excessive daytime sleepiness are the most common symptoms of obstructive sleep apnea (OSA) 11 and despite several reasons to hypothesize that PLWH are at higher risk than the general population for developing OSA, few studies have described the prevalence and/or factors contributing to OSA among PLWH.…”

Multidimensional health status of HIV-infected outpatients at a tertiary care center in north India

“…[26] Therefore, it is important for physicians to address this problem using the available treatment options. [27] The second most prevalent problem was that of lack of energy in the body, or fatigue (96.4%). Other studies have also reported it to be one of the common problems.…”