Fatigue often accompanies depression: people dealing with depression lose not only a sense of hope but also their physical energy. Fatigue is also an indirect result of HIV infection. In this case, it is usually accompanied by weight loss, fever, and night sweats. These symptoms are most likely to occur relatively late in the course of the infection when the CD4 count is low, usually well below 300. HIV infection causes fatigue by depriving the body of some of its sources of energy. People with HIV infection often have anemia, or lower numbers of red blood cells. Red blood cells, among other things, carry oxygen; oxygen supplies the muscles with energy. People with fewer red blood cells therefore have less energy and tire easily, though the anemia must be severe before people notice symptoms. In addition, people with HIV infection sometimes have diarrhea. With diarrhea, food is eliminated from the body before being absorbed, so food is also unavailable as a source of energy. Again, the diarrhea must be severe or last for several weeks to cause the fatigue that accompanies malnutrition. For some people, fatigue is caused by opportunistic infections like MAI or CMV. Medications can also cause fatigue or sleepiness, which is often interpreted as fatigue. These medications include, among others, narcotics, antihistamines, and antidepressants.
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