AIDS and Behavior

, Volume 14, Issue 6, pp 1415–1427 | Cite as

Physiological and Psychosocial Factors that Predict HIV-Related Fatigue

  • Julie Barroso
  • Bradley G. Hammill
  • Jane Leserman
  • Naima Salahuddin
  • James L. Harmon
  • Brian Wells Pence
Original Paper


Fatigue is one of the most common and debilitating symptoms experienced by HIV-infected people. We report the results of our longitudinal analysis of physiological and psychosocial factors that were thought to predict changes in HIV-related fatigue in 128 participants over a 1-year period, in an effort to sort out the complex interplay among a comprehensive set of physiological and psychosocial variables. Physiological measures included hepatic function (aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transpeptidase, alkaline phosphatase, total bilirubin, hepatitis C status), thyroid function (thyroid stimulating hormone, thyroxine), HIV viral load, immunologic function (CD4, CD8, CD4/CD8 ratio, CD16, CD8CD38), gonadal function (testosterone, dehydroepiandrosterone), hematologic function (hemoglobin, hematocrit, serum erythropoietin), and cellular injury (lactic acid). Psychosocial measures included childhood and adult trauma, anxiety, depression, social support, stressful life events, and post-traumatic stress disorder (PTSD). Unemployment, not being on antiretroviral therapy, having fewer years since HIV diagnosis, more childhood trauma, more stressful life events, less social support, and more psychological distress (e.g., PTSD, anxiety and depression) put HIV-infected persons at risk for greater fatigue intensity and fatigue-related impairment in functioning during 1-year follow-up. Physiological variables did not predict greater fatigue. Stressful life events had both direct and indirect effects on fatigue.


HIV Fatigue Stressful life events Physiological factors Psychosocial factors 



The study featured here, entitled Fatigue in HIV-Positive People, is funded by the National Institute of Nursing Research, National Institutes of Health (NIH), 5R01NR008681, Sept. 1, 2004–May 31, 2009 (Julie Barroso, principal investigator), and grant number 1UL1RR024128-01, National Center for Research Resources, Duke CTSI, NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR, NINR, or NIH.


  1. 1.
    Breitbart W, McDonald MV, Rosenfeld B, Monkman ND, Passik S. Fatigue in ambulatory AIDS patients. J Pain Symptom Manag. 1998;15:159–67.CrossRefGoogle Scholar
  2. 2.
    Duran S, Spire B, Raffi F, Walter V, Bouhour D, Journot V, et al. Self-reported symptoms after initiation of a protease inhibitor in HIV-infected patients and their impact on adherence to HAART. HIV Clin Trials. 2001;2:38–45.CrossRefPubMedGoogle Scholar
  3. 3.
    Fontaine A, Larue F, Lassaunière J. Physicians’ recognition of the symptoms experienced by HIV patients: how reliable? J Pain Symptom Manag. 1999;18:263–70.CrossRefGoogle Scholar
  4. 4.
    Henderson M, Safa F, Easterbrook P, Hotopf M. Fatigue among HIV-infected patients in the era of highly active antiretroviral therapy. HIV Med. 2005;6:347–52.CrossRefPubMedGoogle Scholar
  5. 5.
    Voss JG. Predictors and correlates of fatigue in HIV/AIDS. J Pain Symptom Manag. 2005;29:173–84.CrossRefGoogle Scholar
  6. 6.
    Darko DF, McCutchan JA, Kripke DF, Gillin JC, Golshan S. Fatigue, sleep disturbance, disability, and indices of progression of HIV infection. Am J Psychiatry. 1992;149:514–20.PubMedGoogle Scholar
  7. 7.
    Lee KA, Portillo CJ, Miramontes H. The fatigue experience for women with human immunodeficiency virus. JOGN Nurs. 1999;28:193–200.Google Scholar
  8. 8.
    Walker K, McGown A, Jantos M, Anson J. Fatigue, depression, and quality of life in HIV-positive men. J Psychosoc Nurs Ment Health Serv. 1997;35:32–40.PubMedGoogle Scholar
  9. 9.
    Barroso J, Carlson JR, Meynell J. Physiological and psychological markers associated with HIV-related fatigue. Clin Nurs Res. 2003;12:49–68.CrossRefPubMedGoogle Scholar
  10. 10.
    Justice AC, Rabeneck L, Hays RD, Wu AW, Bozzette SA. Sensitivity, specificity, reliability, and clinical validity of provider-reported symptoms: a comparison with self-reported symptoms. J Acquir Immune Defic Syndr. 1999;21:126–33.PubMedGoogle Scholar
  11. 11.
    Perkins DO, Leserman J, Stern RA, Baum SF, Liao D, Golden RN, et al. Somatic symptoms and HIV infection: relationship to depressive symptoms and indicators of HIV disease. Am J Psychiatry. 1995;152:1776–81.PubMedGoogle Scholar
  12. 12.
    Sullivan PS & Dworkin MS. Prevalence and correlates of fatigue among persons with HIV infection. J Pain Symptom Manag. 2003;25:329–33.CrossRefGoogle Scholar
  13. 13.
    Vlahov D, Munoz A, Solomon L, Astemborski J, Anderson J, Galai N, et al. Comparison of clinical manifestations of HIV disease between male and female injecting drug users. AIDS. 1994;8:819–23.CrossRefPubMedGoogle Scholar
  14. 14.
    Vogl D, Rosenfeld B, Breitbart W, Thaler H, Passik S, McDonald M, et al. Symptom prevalence, characteristics, and distress in AIDS outpatients. J Pain Symptom Manag. 1999;18:253–62.CrossRefGoogle Scholar
  15. 15.
    Ferrando S, Evans S, Goggin K, Sewell M, Fishman B, Rabkin J. Fatigue in HIV illness: relationship to depression, physical limitations, and disability. Psychosom Med. 1998;60:759–64.PubMedGoogle Scholar
  16. 16.
    Simmonds MJ, Novy D, Sandoval R. The differential influence of pain and fatigue on physical performance and health status in ambulatory patients with human immunodeficiency virus. Clin J Pain. 2005;21:200–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Groopman JE. Fatigue in cancer and HIV/AIDS. Oncology (Williston Park). 1998;12:335–44. discussion 345–336, 351.Google Scholar
  18. 18.
    Wiener M, Lo Y, Klein RS. Abnormal thyroid function in older men with or at risk for HIV infection. HIV Med. 2008;9:544–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Rondanelli M, Solerte SB, Fioravanti M, Scevola D, Locatelli M, Minoli L, et al. Circadian secretory pattern of growth hormone, insulin-like growth factor type I, cortisol, adrenocorticotropic hormone, thyroid-stimulating hormone, and prolactin during HIV infection. AIDS Res Hum Retroviruses. 1997;13:1243–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Schürmeyer TH, Müller V, von zur Mühlen A, Schmidt RE. Thyroid and adrenal function in HIV-infected outpatients. Eur J Med Res. 1997;2:220–6.PubMedGoogle Scholar
  21. 21.
    Rabkin JG, Wagner GJ, Rabkin R. A double-blind, placebo-controlled trial of testosterone therapy for HIV-positive men with hypogonadal symptoms. Arch Gen Psychiatry. 2000;57:141–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Rabkin JG, Ferrando SJ, Wagner GJ, Rabkin R. DHEA treatment for HIV+ patients: effects on mood, androgenic and anabolic parameters. Psychoneuroendocrinology. 2000;25:53–68.CrossRefPubMedGoogle Scholar
  23. 23.
    Bartlett JG, Gallant JE. Medical management of HIV infection. Baltimore, MD: Johns Hopkins University Department of Infectious Diseases; 2000.Google Scholar
  24. 24.
    Koch J, Kim LS, Friedman S. Gastrointestinal manifestation of HIV disease. HIV InSite Knowledge Base. [cited Jan 26, 2009].
  25. 25.
    Braitstein P, Montessori V, Chan K, Montaner JSG, Schechter MT, O’Shaughnessy MV, et al. Quality of life, depression and fatigue among persons co-infected with HIV and hepatitis C: outcomes from a population-based cohort. AIDS Care. 2005;17:505–15.CrossRefPubMedGoogle Scholar
  26. 26.
    Cruess DG, Douglas SD, Petitto JM, Leserman J, Ten Have T, Gettes D, et al. Association of depression, CD8+ T lymphocytes, and natural killer cell activity: implications for morbidity and mortality in human immunodeficiency virus disease. Curr Psychiatry Rep. 2003;5:445–50.CrossRefPubMedGoogle Scholar
  27. 27.
    Bofill M, Borthwick NJ. CD38 in health and disease. Chem Immunol. 2000;75:218–34.CrossRefPubMedGoogle Scholar
  28. 28.
    Deterre P, Berthelier V, Bauvois B, Dalloul A, Schuber F, Lund F. CD38 in T- and B-cell functions. Chem Immunol. 2000;75:146–68.CrossRefPubMedGoogle Scholar
  29. 29.
    Allen DG. Skeletal muscle function: role of ionic changes in fatigue, damage, and disease. Clin Exp Pharmacol Physiol. 2004;31:485–93.CrossRefPubMedGoogle Scholar
  30. 30.
    Barroso J. “Just worn out”: a qualitative study of HIV-related fatigue. In: Funk SG, Tornquist EM, Leeman J, editors. Key aspects of preventing and managing chronic illness. New York: Springer; 2001. p. 183–94.Google Scholar
  31. 31.
    Barroso J, Lynn MR. Psychometric properties of the HIV-Related Fatigue Scale. J Assoc Nurses AIDS Care. 2002;13:66–75.CrossRefPubMedGoogle Scholar
  32. 32.
    Millikin CP, Rourke SB, Halman MH, Power C. Fatigue in HIV/AIDS is associated with depression and subjective neurocognitive complaints but not neuropsychological functioning. J Clin Exp Neuropsychol. 2003;25:201–15.CrossRefPubMedGoogle Scholar
  33. 33.
    Phillips KD, Sowell RL, Rojas M, Tavakoli A, Fulk LJ, Hand GA. Physiological and psychological correlates of fatigue in HIV disease. Biol Res Nurs. 2004;6:59–74.CrossRefPubMedGoogle Scholar
  34. 34.
    Sexton KA, Francis K, Dugas, MJ. Generalized anxiety disorder. In: Hersen M, Rosqvist J, editors. Handbook of psychological assessment, case conceptualization, and treatment, Vol 1: adults. Hoboken, NJ: John Wiley & Sons Inc; 2008. p. 291–318.Google Scholar
  35. 35.
    Sewell MC, Goggin KJ, Rabkin JG, Ferrando SJ, McElhiney MC, Evans S. Anxiety syndromes and symptoms among men with AIDS: a longitudinal controlled study. Psychosomatics. 2000;41:294–300.CrossRefPubMedGoogle Scholar
  36. 36.
    Barroso J, Preisser JS, Leserman J, Gaynes BN, Golden RN, Evans DN. Predicting fatigue and depression in HIV-positive gay men. Psychosomatics. 2002;43:317–25.CrossRefPubMedGoogle Scholar
  37. 37.
    Leserman J, Barroso J, Pence BW, Salahuddin N, Harmon JL. Trauma, stressful life events and depression predict HIV-related fatigue. AIDS Care. 2008;20:1258–65.CrossRefPubMedGoogle Scholar
  38. 38.
    Honn VJ, Bornstein RA. Social support, neuropsychological performance, and depression in HIV infection. J Intl Neuropsychol Soc. 2002;8:436–47.Google Scholar
  39. 39.
    Murphy DA, Moscicki AB, Vermund SH, Muenz LR. Psychological distress among HIV+ adolescents in the REACH study: effects of life stress, social support, and coping. J Adolesc Health. 2000;27:391–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Roberts JE, Ciesla JA, Direnfeld DM, Hewitt RG. Emotional distress among HIV-positive individuals: the roles of acute negative life events and psychological diatheses. Pers Individ Dif. 2001;30:241–57.CrossRefGoogle Scholar
  41. 41.
    Whetten K, Reif S, Whetten R, Murphy-McMillan LK. Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care. Psychosom Med. 2008;70:531–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Harmon JL, Barroso J, Pence BW, Leserman J, Salahuddin N. Demographic and illness-related variables associated with HIV-related fatigue. J Assoc Nurses AIDS Care. 2008;19:90–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Barroso J, Pence BW, Salahuddin N, Harmon JL, Leserman J. Physiological correlates of HIV-related fatigue. Clin Nurs Res. 2008;17:5–19.CrossRefPubMedGoogle Scholar
  44. 44.
    Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14:245–58.CrossRefPubMedGoogle Scholar
  45. 45.
    Kilpatrick DG, Resnick HS. PTSD associated with exposure to criminal victimization in clinical and community populations. In: Davidson JRT, Foa EB, editors. Posttraumatic stress disorder: DSM-IV and beyond. Washington, DC: American Psychiatric Press; 1993. p. 113–43.Google Scholar
  46. 46.
    Leserman J, Drossman DA, Li Z, Toomey TC, Nachman G, Glogau L. Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status. Psychosom Med. 1996;58:4–15.PubMedGoogle Scholar
  47. 47.
    Leserman J, Whetten K, Lowe K, Stangl D, Swartz MS, Thielman NM. How trauma, recent stressful events, and PTSD affect functional health status and health utilization in HIV-infected patients in the south. Psychosom Med. 2005;67:500–7.CrossRefPubMedGoogle Scholar
  48. 48.
    Leserman J, Pence BW, Whetten K, Mugavero MJ, Thielman NM, Swartz MS, et al. Relation of lifetime trauma and depressive symptoms to mortality in HIV. Am J Psychiatry. 2007;164:1707–13.CrossRefPubMedGoogle Scholar
  49. 49.
    Leserman J, Jackson ED, Petitto JM, Golden RN, Silva SG, Perkins DO, et al. Progression to AIDS: the effects of stress, depressive symptoms, and social support. Psychosom Med. 1999;61:397–406.PubMedGoogle Scholar
  50. 50.
    Leserman J, Petitto JM, Golden RN, Gaynes BN, Gu H, Perkins DO, et al. Impact of stressful life events, depression, social support, coping, and cortisol on progression to AIDS. Am J Psychiatry. 2000;157:1221–8.CrossRefPubMedGoogle Scholar
  51. 51.
    Leserman J, Petitto JM, Gu H, Gaynes BN, Barroso J, Golden RN, et al. Progression to AIDS, a clinical AIDS condition and mortality: psychosocial and physiological predictors. Psychol Med. 2002;32:1059–73.CrossRefPubMedGoogle Scholar
  52. 52.
    Dohrenwend BS, Krasnoff L, Askenasy AR, Dohrenwend BP. Exemplification of a method for scaling life events: the Peri Life Events Scale. J Health Soc Behav. 1978;19:205–29.CrossRefPubMedGoogle Scholar
  53. 53.
    Brown GW, Harris TO. Social origins of depression: a study of psychiatric disorder in women. 1st ed. New York: Free Press; 1978.Google Scholar
  54. 54.
    Beck AT, Steer RA, Brown GK. BDI-II Beck depression inventory: manual. 2nd ed. San Antonio, TX: Psychological Corp; 1996.Google Scholar
  55. 55.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMedGoogle Scholar
  56. 56.
    Savard J, Laberge B, Gauthier JG, Ivers H, Bergeron MG. Evaluating anxiety and depression in HIV-infected patients. J Pers Assess. 1998;71:349–67.CrossRefPubMedGoogle Scholar
  57. 57.
    Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32:705–14.CrossRefPubMedGoogle Scholar
  58. 58.
    Zlotnick C, Davidson J, Shea MT, Pearlstein T. Validation of the Davidson Trauma Scale in a sample of survivors of childhood sexual abuse. J Nerv Ment Dis. 1996;184:255–7.CrossRefPubMedGoogle Scholar
  59. 59.
    Hedeker D. An introduction to growth modeling. In: Kaplan D, editor. The Sage handbook of quantitative methodology for the social sciences. Thousand Oaks, CA: Sage Publications; 2004. p. 215–34.Google Scholar
  60. 60.
    Briere JN, Elliott DM. Immediate and long-term impacts of child sexual abuse. Future Child. 1994;4:54–69.CrossRefPubMedGoogle Scholar
  61. 61.
    Briere J, Elliott DM. Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse Negl. 2003;27:1205–22.CrossRefPubMedGoogle Scholar
  62. 62.
    Briere J, Runtz M. Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse Negl. 1988;12:51–9.CrossRefPubMedGoogle Scholar
  63. 63.
    Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82.CrossRefPubMedGoogle Scholar
  64. 64.
    MacKinnon DP. Analysis of mediating variables in prevention and intervention research. NIDA Res Monogr. 1994;139:127–53.PubMedGoogle Scholar
  65. 65.
    MacKinnon DP, Fairchild AJ, Fritz MS. Mediation analysis. Annu Rev Psychol. 2007;58:593–614.CrossRefPubMedGoogle Scholar
  66. 66.
    Kleinbaum DG, Kupper LL, Muller KE, Nizam A. Applied regression analysis and other multivariable methods. 3rd ed. Pacific Grove, CA: Duxbury Press; 1998.Google Scholar
  67. 67.
    Pence BW, Reif S, Whetten K, et al. Minorities, the poor, and survivors of abuse: HIV-infected patients in the U.S. Deep South. South Med J. 2007;100:1114–22.PubMedGoogle Scholar
  68. 68.
    Aschengrau A, Seage G. Essentials of epidemiology in public health. 2nd ed. Sudbury, MA: Jones & Bartlett Publishers; 2003.Google Scholar
  69. 69.
    Pence BW, Barroso J, Harmon JL, Leserman J, Salahuddin N, Hammill BG. Chronicity and remission of fatigue in patients with established HIV infection. AIDS Patient Care STDs. 2009;23:239–44.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Julie Barroso
    • 1
  • Bradley G. Hammill
    • 2
  • Jane Leserman
    • 3
  • Naima Salahuddin
    • 1
  • James L. Harmon
    • 1
  • Brian Wells Pence
    • 4
  1. 1.School of NursingDuke UniversityDurhamUSA
  2. 2.Duke Clinical Research InstituteDuke University Medical CenterDurhamUSA
  3. 3.Department of Psychiatry, School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of Community and Family Medicine, Duke Global Health Institute, and Center for Health PolicyDuke UniversityDurhamUSA

Personalised recommendations