Document Detail

Predictors and treatment strategies of HIV-related fatigue in the combined antiretroviral therapy era.
MedLine Citation:
PMID:  20523204     Owner:  NLM     Status:  MEDLINE    
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.
Eefje Jong; Lisanne A Oudhoff; Cynthia Epskamp; Marlies N Wagener; Miranda van Duijn; Steven Fischer; Eric Cm van Gorp
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  AIDS (London, England)     Volume:  24     ISSN:  1473-5571     ISO Abbreviation:  AIDS     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-11     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  1387-405     Citation Subset:  IM; X    
Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands.
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MeSH Terms
Antiretroviral Therapy, Highly Active
Anxiety / complications,  drug therapy*,  psychology
CD4 Lymphocyte Count
Fatigue / drug therapy*,  etiology,  psychology
HIV Infections / complications*,  drug therapy,  psychology
Risk Factors
Stress, Psychological
Viral Load

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