Fatigue is a common problem among people with HIV. A 2003 American survey of 13,768 people with HIV found that 37 percent had fatigue “that was the primary reason for a medical visit,” was persistent or was severe enough to stop them from working.

HIV-associated fatigue doesn’t usually have just one cause, so it often takes some time to find a successful treatment. Anaemia is one of the first things many doctors will look for. Low levels of thyroid hormones, testosterone or DHEA are other possibilities; these are all well known with HIV. Nutritional deficiencies can be another major contributor to fatigue.

Sometimes it is fairly clear that anti-HIV drugs are causing fatigue, particularly when the problem occurs when you start a new drug combination or stops when you switch combinations.

Nucleoside analogue drugs can be toxic the mitochondria — the vital energy-producing components inside our cells. These drugs work by interrupting the replication of HIV, but can also interfere with the mitochondrial DNA, preventing the mitochondria from supplying energy to the cell. Once this happens, fatigue is a likely result.

If changing drugs or taking a break from treatment is not an option, one of the first complementary treatments to think of for drug-related fatigue is a nutritional supplement called Co-enzyme Q10, (CoQ10). CoQ10 helps enhance the energy production process and “side-step” the damage caused by HIV medications.

Try a dose of around 60–100 milligrams daily to start. Some people notice an improvement in energy the same day. However, some people need a higher dose (100–200mg in divided doses) for three to four weeks to get a response. CoQ10 was a mainstay for naturopaths in the 1980s treating the debilitating exhaustion caused by monotherapy with high dose AZT.

Unfortunately, CoQ10 is expensive, however many state AIDS Councils and PLWHA groups operate discount vitamin schemes which include subsidised CoQ10. Check with your local groups.

A double-blind study completed last year among people who had had a recent heart attack found that of those taking 120mg of CoQ10/day only 7 percent experienced fatigue, compared with 41 percent of those not using CoQ10.

By the way, CoQ10 can have a significant positive impact on chronic gum disease as well.

Many other vitamins and minerals are needed to manufacture energy. Chief among these are the B complex vitamins, carnitine, n-acetyl-cysteine and magnesium.

There are also many herbs traditionally used to treat fatigue. Ginseng is one that many people will have heard of, but there’s also astragalus or codonopsis from China, withania from India, Siberian or American ginseng, liquorice or oats.

However, these herbs won’t treat all different types of fatigue.

Try this checklist. Do you wake up feeling OK but feel more exhausted as the day goes on? Do you have little stamina and are soon tired out if you need to expend some energy? Do your symptoms appear or get worse after only a little exertion? Do you tend to have chronic loose stools that aren’t due to medical drugs or a gut bug?

If this sounds like you, herbs such as ginseng and the others mentioned above may be a big help. Consulting a professional herbalist, naturopath or Chinese medical practitioner will nearly always give better results than prescribing herbs for yourself.

When you wake up in the morning do you feel just as tired as when you went to bed but tend to improve as the day goes on? When you’ve been sitting or lying down do you tend to feel really “heavy” and find it hard to get up, but when you make a start and are moving around it’s not so bad? Do you find it hard to cope with wet or damp environments — for example, a sauna, a wet rainy day or the humid tropics?

If this sounds more like you then it’s likely that the herbs mentioned above aren’t the right ones for you and a professional consultation is recommended.

A strategy for treating persistent fatigue might go like this: get a full blood count to check for problems like anaemia and include checks for thyroid hormone levels, testosterone and DHEA. Visit a HIV knowledgeable dietician if you’re not totally confident about your diet. If these actions don’t solve the problem then consult a HIV-competent natural therapist to get professional guidance.

*Jim Arachne* is the Complementary Therapy Treatment Officer for the Victorian AIDS Council.

References

¹ “Prevalence and correlates of fatigue among persons with HIV infection.” J Pain Symptom Manage. 2003 Apr;25(4):329-33. Sullivan PS and Dworkin MS.

² “Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction.” Mol Cell Biochem. 2003 Apr;246(1-2):75-82. Singh RB, Neki NS, Kartikey K, et al.