Sick and Tired

Monday was the 20th World AIDS Day, but "celebration is such an odd word for it," assistant dean Michael Relf told a small brown bag session at the School of Nursing.

Today, an estimated 33 million people carry HIV, of which two-thirds are in sub-Saharan Africa, where Relf does much of his research. As the virus spreads most viciously among the poor, the uneducated, the young and the female, "we're seeing the epidemic start over," he said. Completely depressing.

His colleague, associate professor Julie Barroso, is studying the psychic toll HIV infection takes on American patients, many of whom have been living with it for ten years or more. She presented preliminary data from an ambitious NIH-funded study that is measuring a dizzying array of physiologic and psychosocial factors in a cohort of 128 patients over time. What they're looking for is some predictors of the debilitating fatigue that many HIV-positive people experience. So far, the physiology -- liver function, thyroid, testosterone, viral lode, CD4 cell counts, etc. -- doesn't correlate at all with fatigue. But the psychic factors -- experiences of trauma, PTSD, depression, anxiety, lack of social support, etc. -- are ALL correlated with fatigue.

But there it gets tricky: Do HIV patients experience fatigue because they've got this infection (and all that it symbolizes) lurking over them, or does their stressful, traumatic, unsupported past make them feel more poorly?
Relf pointed out that trauma in childhood and adulthood are themselves predictive of HIV-positive status.

Clearly, another case where an ounce of prevention would save untold lives and resources. The other bottom line: Society, here and in Africa, needs to treat more than the HIV patient's symptoms. "Each of us can do something," Relf said. "Even if it's just listening to someone."