One of the most difficult and frustrating problems for people who test positive for HIV, the virus that causes AIDS, is fatigue, but often doctors can't recommend much more to patients than getting additional rest. Unfortunately, more rest rarely helps, and some victims of the illness report being so tired that they must stop working altogether. Now, a new pilot study by researchers at the University of North Carolina at Chapel Hill suggests that different factors -- or possibly a combination of several including depression and anxiety -- are responsible for patients' excessive tiredness.
Other contributors, researchers found, appear to be lower than normal amounts of hemoglobin, the complex molecule that carries oxygen to tissues; lower than normal hematocrit, which indicates the proportion of cells and fluids in the blood; and low levels of CD4 cells, the immune system defensive cells that the AIDS virus slowly destroy.
The UNC team studied 40 otherwise healthy HIV-positive patients in depth, collecting numerous test results at the UNC General Clinical Research Center. Besides recording physiological and nutritional data, scientists had patients complete five detailed questionnaires designed to measure how much depression, anxiety and fatigue they felt.
"We found that in many of our patients, more fatigue corresponded with people having fewer CD4 cells, lower hemoglobin and lower hematocrit," said Dr. Julie Barroso, assistant professor at the UNC School of Nursing. "We also had an interesting group of people who were statistically significant and different from the others in that they were fatigued but were not low on those measures."
When researchers looked at the sub-group more closely, they found fatigue corresponded strongly with high scores on the depression and anxiety tests, said Barroso, the principal investigator. Higher viral load, meaning increased levels of HIV in patients' blood, did not correspond with increased fatigue.
"We can't say that anxiety and depression in HIV-positive people cause fatigue, but still the findings are pretty interesting and suggestive," she said. "If they are found in larger studies to cause the fatigue, then we might be able to help patients by treating those problems."
Barroso presented results of the study at the American Foundation for AIDS Research's 13th National HIV/AIDS Update Conference March 22 in San Francisco. Co-authors of the study are Drs. John Carlson, research assistant professor of nursing; Joe Eron, associate professor of medicine and an AIDS expert; Jane Leserman-Madison, research associate professor of psychiatry; and Virginia J. Neelon, associate professor of nursing.
Earlier studies have indicated that about 20 percent of HIV patients suffer from chronic fatigue, but Barroso said that in her experience, the number could be as high as 60 percent. Many researchers have already looked at factors contributing to fatigue, although the UNC faculty members believe theirs is the first to examine so many in combination.
More work is needed to confirm and expand on the team's findings, Barroso said.
"This is one place to start, as opposed to just saying to people, 'Well you are fatigued. We don't know what to do about this,'" she said. "It certainly shows that such patients should be assessed for depression and anxiety and treated if necessary."
Some excessively tired patients have even had to change the way the parent their children or grandchildren, the clinician said.
"One lady described to me having to sit down to take clothes out of the dryer, and it's hard to imagine such a simple task being so tiring," Barroso said. "We hope to come up with some interventions that will give these people some relief."
