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Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era

Jong, Eefjea,b; Oudhoff, Lisanne Ac,*; Epskamp, Cynthiac,*; Wagener, Marlies Nd,e; van Duijn, Mirandae,f; Fischer, Steveng; van Gorp, Eric CMa,h

doi: 10.1097/QAD.0b013e328339d004

Objective: To assess predictors and reported treatment strategies of HIV-related fatigue in the combined antiretroviral (cART) era.

Method: Five databases were searched and reference lists of pertinent articles were checked. Studies published since 1996 on predictors or therapy of HIV-related fatigue measured by a validated instrument were selected.

Results: A total of 42 studies met the inclusion criteria. The reported HIV-related fatigue prevalence in the selected studies varied from 33 to 88%. The strongest predictors for sociodemographic variables were unemployment and inadequate income. Concerning HIV-associated factors, the use of cART was the strongest predictor. Comorbidity and sleeping difficulties were important factors when assessing physiological influences. Laboratory parameters were not predictive of fatigue. The strongest and most uniform associations were observed between fatigue and psychological factors such as depression and anxiety. Reported therapeutic interventions for HIV-related fatigue include testosterone, psycho-stimulants (dextroamphetamine, methylphenidate hydrochloride, pemoline, modafinil), dehydroepiandrosterone, fluoxetine and cognitive behavioural or relaxation therapy.

Conclusion: HIV-related fatigue has a high prevalence and is strongly associated with psychological factors such as depression and anxiety. A validated instrument should be used to measure intensity and consequences of fatigue in HIV-infected individuals. In the case of fatigue, clinicians should not only search for physical mechanisms, but should question depression and anxiety in detail. There is a need for intervention studies comparing the effect of medication (antidepressants, anxiolytics) and behavioural interventions (cognitive-behavioural therapy, relaxation therapy, graded exercise therapy) to direct the best treatment strategy. Treatment of HIV-related fatigue is important in the care for HIV-infected patients and requires a multidisciplinary approach.

aDepartment of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands

bDepartment of Infectious Diseases, University Medical Center, Utrecht, The Netherlands

cUniversity of Amsterdam, Amsterdam, The Netherlands

dCenter of Excellence Participation Occupation and Health, Rotterdam University of Applied Science, Hogeschool Rotterdam, Rotterdam, The Netherlands

eDepartment of Integrative Medicine, The Netherlands

fDepartment of Rehabilitation Medicine, The Netherlands

gDepartment of Psychology, Slotervaart Hospital, Amsterdam, The Netherlands

hDepartment of Virology, Erasmus Medical Center, Rotterdam, The Netherlands.

*L.A.O. and C.E. contributed equally to the writing of this article.

Received 4 December, 2009

Revised 5 March, 2010

Accepted 15 March, 2010

Correspondence to Eefje Jong, Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam, The Netherlands. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.