Question
Is general weakness and other symptoms related to HIV or starting meds?
13 June 2007. Related: All topics, Side effects, Starting treatment.
Hi
My girlfriend has recently started HAART, she complains often of feeling very weak.
She is eating well and is otherwise well. Recent blood tests, CT-scan of the head, ultrasound of the abdomen and x-ray chest are all normal. Why is this happening?
Is this a reaction to her medication or due to progression of the disease? her CD4 count was 101 recently.
She is unable to work due to her weakness. She is also having tremors whenever she makes an effort to work.
Answer
Hi
Without more information (whether she was ill before treatment, which treatment she is using etc) it is difficult to answer your questions, but there are four general possibilities:
1. If she had symptoms before starting treatment, then this is probably related to HIV.
2. That these are general side effects from starting treatment – fatigue and weakness – feeling tired etc often occur in the first few weeks until your body get used to medication. These are generally mild though and if your girlfriends is feeling work each day then this is likely to be more serious.
3. That it is a side effect of both HIV drugs or preventative treatment like cotrimoxazole (to protect against PCP with low CD4 counts) – but you didn’t say which drugs she is taking. A few rare side effects can be very serious and so her doctor should be checking for these – ie liver toxicity with nevirapine or a hypersensitivity reaction, or lactic acidosis with d4T
4. That starting treatment generated an immune response that prompted an underlying infection to become active, called Immune Reconstitution Syndrome (IRS) or Immune Reconstitution Inflammatory Syndrome (IRIS). This is often TB but can be any opportunistic infection (PCP, CMV, MAI, hepatitis etc). It is not uncommon in people starting treatment with a low CD4 count (it occurs in perhaps up to 25% people) but has to be taken very seriously by her doctor.
- A summary protocol for IRS that your doctor should be following is here.
- Guidelines for treating TB-related IRIS are here.
- A report showing the range of infections that IRIS can cover is here
Ask the doctor which of these four options is going on and check he is aware of these and similar resources.
Finally, you emails all come via the website and because you don’t include your email address I can’t contact you more quickly directly. Even when you include your email address to me, this will never be public on the website.
Please email me privately if you have other direct questions.
Hi Zoleka,
I’m sorry to hear about your recent diagnosis. But it’s good to hear you’ve started HIV treatment.
However, treating TB and HIV together is complex. So it’s important to talk to your doctor about your symptoms. You can also ask your doctor to give you access to your CD4 count and viral load results. Please let us know what they are.
If you live in South Africa you can contact the Treatment Action Campaign (TAC) at this contact link. They can give local support.
Hey recently find out that Iam HIV positive and I started AZT treatment 3 weeks back & they also gave me TB treatment to take but I feel so weak everyday & my back feels very hot and I don’t know my CD4 count & viral load, What do you think might be the cause of this?
Hi John.
If your mother is feeling like this, she needs to see a doctor.
My mum started treatment of HIV and ever since she has become so weak and often forget thing even if you talk to her she will respond slowly and yo some she won’t and also severe headache is also making for confused please what is the remedy
Hi Nelly,
I’m sorry your sister is unwell. However, as it says on the answer above, it could be due to the immune system recovering from a low CD4 count. This is called IRIS. Please see this link for more info about IRIS. But your sister should discuss all the symptoms with the doctor to check what’s causing them.
my sister delayed going for arvs, now she is always so weak,after a month of starting with HIV treatment,she underwent usual symptoms, like nausea, dizziness confussion, and lack of appetite. what is worrying us now is constant weakness of arms and legs. what could this be?