HIV-Associated Fatigue — SCE Infectious Diseases MCQ

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EasyHIV MedicineHIV-Associated FatigueSCE Infectious Diseases

A 30-year-old man with HIV on ART develops unexplained chronic fatigue. His CD4 is 580 and VL <50. All standard investigations (FBC, TFTs, iron studies, B12/folate, cortisol) are normal. What is the most likely explanation?

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Correct answer: A — HIV-associated fatigue — a common symptom in PLWH even with viral suppression, likely related to chronic immune activation, ART side effects (particularly EFV, though less with INSTIs), and psychosocial factors

Chronic fatigue is one of the most common symptoms reported by PLWH, affecting 20–60% even with effective ART. It is multifactorial: chronic immune activation (persistent even with suppressed VL), ART side effects (Efavirenz — CNS effects; INSTIs — insomnia, which causes secondary fatigue), depression/anxiety (highly prevalent in PLWH), sleep disturbance, and deconditioning. Management: address modifiable factors (sleep hygiene, exercise, mental health support, ART review if Efavirenz-based), and screen for depression (PHQ-9).

Reference: BHIVA 2022 – HIV and wellbeing; NICE CKS 2024 – Fatigue