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Fatigue in HIV-Positive People

Fatigue in HIV-Positive People. Julie Barroso, PhD, ANP, APRN, BC Associate Professor and Director, Adult Nurse Practitioner Program Duke University School of Nursing Sept. 2, 2005. Fatigue - What is it?.

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Fatigue in HIV-Positive People

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  1. Fatigue in HIV-Positive People Julie Barroso, PhD, ANP, APRN, BC Associate Professor and Director, Adult Nurse Practitioner Program Duke University School of Nursing Sept. 2, 2005

  2. Fatigue - What is it? • “Fatigue is the Central Africa of medicine, an unexplored territory which few men enter.” • George Beard, 1869

  3. HIV-related fatigue… • Is the most frequent and debilitating complaint of HIV positive people, with an incidence ranging from 20-60% • Is strongly correlated with ratings of average health, ratings of mental health and life satisfaction, and overall quality of life • Is a strong predictor of both limitations of daily activity and disability days

  4. NIH NINR R01 NR08681 • Our overall purpose is to explore the natural course of chronic fatigue in HIV-positive people – the people who develop it, the ways in which they differ from those who do not, the circumstances and consequences associated with fatigue, and the predictors of changes in fatigue.

  5. Specific Aims • Aim 1: To determine the level, circumstances, and consequences of fatigue in a group of community-dwelling HIV-positive individuals. • RQ1a: What levels of fatigue do HIV-positive individuals report experiencing over a 3-year period? • RQ1b: What circumstances do HIV-positive individuals most frequently report as leading to their fatigue? • RQ1c: What consequences do HIV-positive individuals most frequently report as resulting from their fatigue?

  6. Aim 2: To determine at baseline, the relationships of personal and HIV-related variables, and physiological, psychosocial, and sleep quality variables to levels of fatigue in HIV-positive individuals. • RQ2a: Are personal (gender, age, race/ethnicity, socioeconomic status, employment status, family care responsibilities, recreational drug use) and HIV-related variables (length of time with HIV infection, use of antiretroviral therapy, and number and severity of HIV-related illnesses) related to baseline level of fatigue?

  7. RQ2b: Are baseline levels of hepatic function (AST, ALT, GGT, alkaline phosphatase, total bilirubin, and hepatitis C status), thyroid function (TSH, T4), HIV viral load (HIV RNA PCR), immunologic function (CD4, CD8, CD4/CD8 ratio, CD16, CD8CD38), gonadal function (testosterone, DHEA), hematologic function (complete blood count with a differential, particularly hemoglobin and hematocrit; serum erythropoietin), salivary cortisol, and cellular injury (lactic acid) related to baseline level of fatigue in seropositive individuals?

  8. H2a: HIV-infected persons with more baseline anxiety, depression, and stressful life events, and less social support will have significantly higher levels of baseline fatigue. • H2b: HIV-infected persons with worse baseline sleep quality will have significantly higher levels of baseline fatigue.

  9. Aim 3: To examine prospectively the relationships of personal and HIV-related variables and changes in physiological, psychosocial, and sleep quality variables to chronicity of fatigue (percentage of visits fatigued, level of fatigue over time) in HIV-positive individuals. • RQ3a: Are personal (gender, age, race/ethnicity, socioeconomic status, employment status, family care responsibilities, recreational drug use) and HIV-related variables (length of time with HIV infection, use of antiretroviral therapy, and number and severity of HIV-related illnesses) related to chronicity of fatigue?

  10. RQ3b: Are changes in hepatic function (AST, ALT, GGT, alkaline phosphatase, total bilirubin, and hepatitis C status), thyroid function (TSH, T4), HIV viral load (HIV RNA PCR), immunological function (CD4, CD8, CD4/CD8 ratio, CD16, CD8CD38), gonadal function (testosterone, DHEA), hematologic function (complete blood count with a differential, particularly hemoglobin and hematocrit; serum erythropoietin), salivary cortisol, and cellular injury (lactic acid) related to chronicity of fatigue?

  11. H3a: HIV-infected persons with more anxiety, depression, and stressful life events, and less social support over time will have significantly greater chronicity of fatigue. • H3b: HIV-infected persons with worse sleep quality over time will have significantly greater chronicity of fatigue.

  12. Variables: Psychosocial measures • State anxiety – State Trait Anxiety Inventory • Trait anxiety – State Trait Anxiety Inventory • Depression & anxiety – Hospital Anxiety and Depression Scale • Depression – Beck Depression Inventory-II • Social support – Medical Outcomes Study – Social Support Scale • Stress – Stressful Life Events interview • Stress – Perceived Stress Scale • Quality of life – SF-12

  13. Variable: Sleep quality • Sleep quality - Pittsburgh Sleep Quality Index • Daytime sleepiness - Epworth Sleepiness Scale Variable: Personal and HIV-related illness variables • Medical symptom checklist • RA demographic data sheet • Childhood trauma - Trauma Scale • Post-traumatic stress disorder – Davidson Trauma Scale

  14. THANK YOU!!!

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