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Lethargy and tiredness is a frequent problem especially in advanced disease. It may be debilitating and interfere with the ability to carry on working or other routine activities.


Apart from the direct effects of HIV, symptoms of fatigue may be due to anaemia, low testosterone levels, depression and anxiety. Chronic infections such as MAI, which may persist for weeks or months, are an important cause.

If fatigue is accompanied by nausea, tenderness in the abdomen or liver area, weight loss and shortness of breath on NRTI treatment, these symptoms suggest a build-up of lactate, which may develop into lactic acidosis if not treated immediately. See Lactic acidosis in A to Z of illnesses for further details.

What to do

Treatment of underlying medical problems such as anaemia, low testosterone, depression and anxiety, or infections such as MAI may help. If the fatigue is due to HIV and is debilitating then starting or changing HIV treatment may help. Psychological interventions, such as cognitive behavioural therapy, may be helpful in some cases.1

Practical help with routine daily tasks may be needed. Such help may be available from local social services or voluntary HIV/AIDS agencies.

Decisions about whether to give up work and to accept help at home are difficult as they alter people's sense of independence. Specialist HIV social workers, counsellors and advice workers can help in this decision-making and try to provide a range of services that suit needs but continue to respect independence.

See also Anaemia


  1. Jong E et al. Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era. AIDS, 24: online edition, DOI:10 .1097/QAD.0b0113e3283339d004, 2010
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We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.