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Reviewed April 21, 2014

Fact Sheet 551




Fatigue is tiredness that does not go away when you rest. It can be physical or psychological.

With physical fatigue, your muscles cannot do things as easily as they used to. You might notice this when you climb stairs or carry bags of groceries.

With psychological fatigue, it may be difficult to concentrate for as long as you used to. In severe cases, you might not feel like getting out of bed in the morning and doing your regular daily activities.



Fatigue is one of two main ways the body warns you about a problem. The other warning is pain. Most of us pay attention to pain, and stop whatever causes us pain. We don’t pay as much attention to fatigue. One reason might be that fatigue sneaks up on us: it usually gets worse so slowly that we don’t even notice.

People with HIV and fatigue tend to get sicker faster than people without fatigue. Also, ongoing fatigue can weaken the immune system. People with HIV should find out what is causing their fatigue and treat it.



Fatigue can start and increase very slowly. If you feel tired even after you rest, talk with your health care provider about fatigue. Give your health care provider as much information as possible. This will make it easier to know if you are fatigued, and what might be causing it. The following questions are good to think about before you talk to your health care provider about fatigue:

  • How long have you been tired?
  • Compared to a few months ago, how has your activity level changed?
  • How do you feel when you are tired? Are you short of breath? Are your muscles sore? Is it difficult to concentrate or remember? Is it hard to get interested in your daily activities?
  • When are you tired? Is it after certain activities, like climbing stairs? Do you wake up tired?
  • Are you sleeping well? How long do you sleep each night? How many times do you get up? Is it hard to fall asleep or stay asleep because of itching, pain, or other problems



Fatigue can be caused by many different factors. Work with your health care provider to find the cause of your fatigue and the best way to treat it.

  • Active HIV infection. When HIV multiplies rapidly, your body uses a lot of energy trying to fight it. Most people have more energy after they start taking ARVs.
  • Other active infections. Other infections can tire you out, even without obvious symptoms. Parasites in your digestive system, bronchitis, other infections or allergies can cause fatigue. If these infections are treated, your energy should improve.
  • Poor nutrition. People with HIV need more energy than healthy people. If you are not getting enough nutrients, your energy level will be low. Diarrhea can rob your body of nutrients and cause fatigue. See Fact Sheet 554 on diarrhea, 800 on nutrition, and 801 on vitamins. If possible, meet with a dietitian who knows about HIV disease to discuss your eating habits. For some people, vitamin B12 supplements or better nutrition can eliminate fatigue.
  • Anemia (see Fact Sheet 552). The main job of the red blood cells is to carry oxygen from the lungs to the rest of the body. If you don’t have enough red blood cells, or if they aren’t carrying enough oxygen, your fatigue may be caused by anemia. A simple blood test will show whether you have anemia. If you do, your health care provider will determine what is causing anemia. It could be due to blood loss, damage to your bone marrow caused by anti-HIV medications or vitamin deficiencies, or by a low level of the hormone erythropoietin which helps make red blood cells.
  • Low hormone levels. Especially in men, low levels of the sex hormone testosterone can cause fatigue and lack of interest in sex and other normal activities. Low levels of other important hormones such as DHEA (see Fact Sheet 724), cortisol or thyroid can cause similar problems. Hormone levels can be checked with blood tests. Pills, patches, creams, or injections can restore hormone levels to normal.
  • Depression (see fact sheet 558). This is more than just feeling sad. Chemical changes in the brain can cause fatigue and a lack of interest in daily activities. There is no blood test for depression. The chances that you are depressed are higher if you have previously been diagnosed with depression, if you have a history of heavy alcohol or recreational drug use, or if you have a family history of emotional disorders. Depression can be treated with medications. However, some antidepressants can cause problems with sexual functioning. Also, some antidepressants interact with some ARVs, so they must be used very carefully.
  • Lifestyle. Getting enough sleep is important. Habits like smoking or drinking a lot of coffee can make it harder to sleep. Regular exercise can make it easier to sleep.



Fatigue is a very common condition for people with HIV. Untreated fatigue can make HIV disease progress faster.

It can be very difficult to figure out the cause of fatigue. Several different factors can cause the same symptoms. Blood tests can identify some causes but not others. The more information you can give your health care provider, the easier it will be to determine what is causing your fatigue and how to treat it.




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