Fatigue in Ambulatory AIDS Patients

Abstract

Although preliminary reports indicate that fatigue is a common symptom of human immunodeficiency virus (HIV) disease, little empirical research has focused on its prevalence or characteristics among patients with acquired immunodeficiency syndrome (AIDS). We assessed the frequency of fatigue and its medical and psychological correlates, in a cross-sectional survey of ambulatory AIDS patients. Ambulatory patients with AIDS who participated in a study of quality life (N = 427) were classified into fatigue/no fatigue groups based on their responses to fatigue items on the Memorial Symptom Assessment Scale (MSAS) and the AIDS physical symptom checklist. Self-report inventories were also administered to assess psychological distress, depressive symptoms, and overall quality of life. Medical information was elicited through clinical interview and review of medical chart. Fifty-four percent of the patients endorsed both of the fatigue items from the MSAS and the AIDS physical symptom checklists, and were classified as having fatigue. Women were significantly more likely to report fatigue than men (chi square = 5.28, df = 1, P < 0.03), and patients reporting homosexual contact as their transmission risk factor were significantly less likely to report fatigue than were patients reporting injection drug use or heterosexual contact (chi square = 5.13, df = 2, P < 0.03). The presence of fatigue was significantly associated with the number of current AIDS-related physical symptoms [t(425) = 8.00, P < 0.0001], current treatment for HIV-related medical disorders (chi square = 12.51, df = 1, P < 0.0001), anemia [t(174) = -2.35, P < 0.02], and pain (chi square = 36.36, df = 1 P < 0.0001). Patients with fatigue also had significantly poorer physical functioning ability [Karnofsky: t(422) = -6.27, P < 0.0001], as well as greater degree of overall psychological distress and lower quality of life [F(5,418) = 23.79, P < 0.0001], as measured by the Brief Symptom Inventory, Beck Depression Inventory, Beck Hopelessness Scale, Functional Living Inventory for Cancer (modified for AIDS), and the MSAS Psychological Distress Subscale. Fatigue is a common symptom in ambulatory AIDS patients and is associated with significant physical and psychological morbidity.

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

“…Other studies have also reported it to be one of the common problems. [22,[28][29][30] Fatigue has a multifactorial origin [22,29,31] that includes lack of rest or exercise, improper or inadequate diet, psychological stress, anemia, infection, thyroid abnormalities, side effects of medication, sleep disturbances, and fever. Fatigue has not been found to correlate with CD4 counts, [31,32] and this was seen in our study.…”

“…The most prevalent problems of our study -fatigue and emotional problems -often coexist and are interrelated. [29] Many physiological markers and psychological constructs are available for objective assessment of fatigue. [31,33] There is a need for routine assessment and management of fatigue in patients with HIV.…”

Physiological Correlates of HIV-Related Fatigue

“…Anemia may occur as a result of HIV-induced ineffective hematopoiesis, opportunistic infections, infiltrative disease of the bone marrow, nutritional deficiencies, hemolysis, or antiretroviral or other therapy (Breitbart et al, 1998;Ferri et al, 2001;Groopman, 1998;Mocroft et al, 1999;Moore, 1999 (Bartlett & Gallant, 2000;Koch et al, 2001), and as noted above, cytokine release could influence hepatic dysfunction. There is a high prevalence of hepatitis C in seropositive people: it is estimated that 300,000 of the 750,000 HIV-infected individuals in the United States are coinfected with the hepatitis C virus (HCV).…”

“…Some researchers speculate that HIV-related fatigue is a result of physiological factors, whereas others argue that it is a function of psychosocial variables. This report focuses on the relationship of physiological variables and HIV-related fatigue.Address all correspondence to Julie Barroso, Duke University School of Nursing, DUMC 3322, Durham, NC 27710, phone: (919) Barroso, Carlson, & Meynell, 2003;Breitbart, McDonald, Rosenfeld, Monkman, & Passik, 1998;Justice et al, 1999;Perkins et al, 1995; Sullivan, Dworkin, & the Adult and Adolescnt Spectrum of HIV Investigators, 2003;Vlahov et al, 1994;Vogl et al, 1999; Voss, 2002). Henderson, Safa, Easterbrook, & Hotopf (2005) actually found greater fatigue in individuals with higher CD4 counts.…”

A Study on the Self-Reported Quality of Life of HIV-Positive Slum-Dwellers in Mumbai, India

“…Many of the people living with HIV/AIDS find it challenging to attend to the daily routine tasks of living or participate in moderate to vigorous physical activities, or have sufficient energy or vitality to engage in an active social life while managing HIV/AIDS. Fatigue or low energy has been associated with both physical and psychological morbidity and poor quality of life in persons with HIV/AIDS [18,19]. In addition; fatigue and a CD4 T cell count less than 500 are associated with physical limitations and disability [20].…”