Quality of sleep in people living with HIV in the era of highly active antiretroviral treatment

Pathogenesis of HIV-associated depression: contributing factors and underlying mechanisms

Cumulative evidence indicates that compared to HIV negative individuals, people living with HIV (PLWH) have a higher likelihood of developing depression, anxiety, and cognitive disorders. Depression, which is known to be a persistent and overwhelming feeling of sadness accompanied by a loss of interest in usual activities, is one of the most common mental illnesses encountered during HIV infection. Experts believe that several factors such as neuroinflammation, life stressors, lack of sleep, poor nutritional state, opportunistic infections and comorbidities, and HIV medications are contributing factors favoring the development of depression in PLWH. However, the fundamental mechanisms which underlie the involvement of these factors in the emergence of depression in the context of HIV remain poorly explored. Past researches describing the role of one or two of the preceding factors do exist; however, very few articles tackle this important topic while considering the several different putative causative factors comprehensively in the particular context of HIV infection. Herein, we elaborate on the factors currently understood to be responsible for the development of depression, and discuss the particular fundamental mechanisms whereby each factor may result in the outcome of depression. We believe that the understanding of these factors and of their underlying mechanisms is essential for the development of future therapeutic interventions to alleviate the burden of depression commonly seen in PLWH, and therefore facilitate the development of strategies to improve their overall quality of life.

Inhalation aromatherapy for the treatment of comorbid insomnia: a systematic review and meta-analysis

Objective

Meta-analysis can pool multiple studies to explore a particular area in depth, therefore this method was used to explore the clinical efficacy of inhalation aromatherapy for the treatment of comorbid insomnia and provide an empirical evidence for clinical treatment.

Methods

The PubMed, Web of Science, CNKI Database, Wanfang Database, and VIP Database were searched for randomized controlled trials on aromatherapy for the treatment of comorbid insomnia from inception to August 30, 2023. RevMan 5.3 was used for meta-analysis of the results.

Results

A total of 27 publications involving 2072 patients were included. The results of the meta-analysis showed that inhalation aromatherapy well relieved the symptoms of comorbid insomnia (MD -2.90, 95% CI: -3.85 to -1.95, p<0.00001) and the negative mental state of anxiety (MD -3.97, 95% CI: -5.88 to -2.06, p<0.0001) and depression (MD -9.58, 95% CI: -15.13 to -4.03, p=0.0007) in patients. Included studies were heterogeneous, and the factors influencing the heterogeneity were not identified. These studies commonly presented issues such as lack of blinding, and absence of independent testing for the purity or potency of herbs.

Conclusion

Inhalation aromatherapy can improve the sleep quality of patients with other disease states, with basically no adverse reactions and acceptable safety. Therefore, inhalation aromatherapy is expected to become an indispensable complementary therapy in clinical practice for most diseases. However, high-quality clinical trials are still needed to confirm these findings due to methodological weaknesses in blinding and independent testing for the purity and potency of herbs.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023455278.

Associations between multimorbidity burden and objective and patient-reported sleep outcomes among people with HIV

BACKGROUND

We aimed to provide insights into the effects of comorbidities on sleep health in people with HIV by assessing associations between multimorbidity patterns and sleep outcomes in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) sub-study.

METHODS

Principal component analysis identified six multimorbidity patterns among participants with HIV ( n  = 1073) at baseline: cardiovascular diseases (CVDs), sexually transmitted diseases, metabolic, mental/joint, neurological and cancer/other. Burden z scores were calculated for each individual/pattern. A subset of 478 participants completed sleep assessments at follow-up, including questionnaires [Insomnia Severity Index (ISI), Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (SD) and Sleep Related Impairment (SRI)] and overnight oximetry [4% oxygen desaturation index (ODI) and percentage of time with oxygen saturation (SpO 2 ) <90%). Multivariable regression assessed associations between burden z scores and sleep measures.

RESULTS

Amongst 309 participants [median (interquartile range) age 53 (47-59) years], 21% had insomnia (ISI ≥15). Higher Mental/Joint z scores were associated with increased odds of insomnia [aOR 1.06 (95% CI 1.03-1.09)] and worse PROMIS-SRI [1.34 (1.22-1.48)] and PROMIS-SD [1.27 (1.16-1.39)] scores. Higher metabolic and neurological z scores were associated with worse PROMIS-SRI scores ( P  < 0.01). Higher CVDs z scores were associated with worse ISI and PROMIS-SRI scores, and a higher percentage of time with SpO 2 below 90% (all P 's < 0.01).

CONCLUSION

This study is among the first to describe specific multimorbidity patterns linked to poorer sleep outcomes in people with HIV. Findings suggest the need for targeted sleep interventions based on multimorbidity profiles, which may mitigate broader health risks associated with poor sleep.

Examining objective and subjective sleep measures and neurocognition in older adults with HIV: A cross-sectional study in the deep South

As people live longer with HIV, reports of poor sleep and neurocognitive impairments are expected to increase. Poor sleep and neurocognitive impairments commonly occur in people living with HIV (PLWH) and some medications (e.g., anticholinergics) contribute to these problems. The association between sleep and neurocognition among PLWH taking such medications remains unclear. This study examined trend level associations between neurocognitive domains and subjective and objective sleep outcomes. Among 29 PLWH (Mage = 61 years old), the use of anticholinergics and/or antidepressants were examined as a moderator between neurocognition and sleep outcomes. For PLWH taking anticholinergics and/or antidepressants, the associations between insomnia and neurocognitive measures were counter-intuitive, and so were the associations between sleep time and neurocognitive measures. For these adults, objective longer sleep time was associated with poorer verbal learning (immediate, p = .005; delayed recall, p = .002) and visuospatial memory (delayed recall, p = .010). Greater sleep efficiency was associated with better visuospatial memory (immediate, p = .007; delayed recall p = .022). Despite sleep benefits, the use of anticholinergics and/or antidepressants may compromise neurocognitive function in older PLWH. Clinical implications include routine sleep and neurocognitive assessments along with medication monitoring to detect adverse neurocognitive effects of commonly prescribed medications.

Nocturnal systolic blood pressure dipping among people living with HIV and people without HIV: a cross-sectional study in Rural Uganda

Background

In this study, we investigated sleep quality, depression and stress symptoms as hypothesized factors affecting the association between HIV status and nocturnal blood pressure dipping status in rural Uganda.

Methods

Individuals living with HIV (PLHIV) and people without HIV (PwoHIV) underwent 24-hour ambulatory blood pressure monitoring (ABPM) and classified as extreme dippers, dippers and non-dippers based on a percentage nocturnal drop in mean systolic and diastolic blood pressure. Ordinal logistic regression models were used to assess the effect of different exposure variables (HIV status, sleep quality and other covariates) on the outcome (dipping status).

Results

The median age was 45 years (IQR: 35-54) and 80% of the participants were female. 24% of PwoHIV and 16% of PLHIV were overweight, 10% of HIV negative and 3% of the HIV positive individuals were obese. Depression was prevalent in both PLHIV and PwoHIV. Additionally, poor sleep quality was more prevalent in PLHIV compared to PwoHIV (70% versus 58%, P= 0.046). The study found that 53% of participants had normal dipping, while 35.1% were non-dippers, with non-dipping being more prevalent in PwoHIV individuals (34.9% vs 29.7%, P<0.001). PLHIV had 3.6 times the odds of being extreme dippers compared to PwoHIV (OR 3.64, 95% CI: 1.40 - 9.44).

Conclusion

This study identified high proportions of non-dipping BP profiles among both PLHIV and PwoHIV. However, the odds of being extreme dippers were higher among PLHIV compared to PwoHIV. Further research is needed to understand the underlying mechanisms contributing to extreme dipping patterns in PLHIV.

Reversibility of Neuropsychiatric Adverse Events after Switching to Darunavir/Cobicistat or Doravirine in Men on INSTI-Based Regimen

Integrase strand transfer inhibitors (INSTI) are associated with neuropsychiatric adverse events (NPAEs). The aim of this study was to evaluate improvements in NPAEs after switching an INSTI-based regimen to darunavir/cobicistat (DRV/c) or doravirine (DOR). Methods: A prospective cohort study was conducted to evaluate the reversibility of NPAEs via the Patient Health Questionnaire (PHQ-9), the Insomnia Severity Index (ISI), and the Hospital Anxiety and Depression Scale (HADS-A and D) in patients who started antiretroviral therapy with dolutegravir (DTG) or bictegravir (BIC). These patients were switched to DRV/c or DOR. Scales were compared at the moment of the switch and 12 weeks later. Results: We included 1153 treatment-naïve men, 676 (58.7%) with BIC and 477 (41.3%) with DTG. A total of 32 (2.7%) experienced NPAEs that led to discontinuation. Insomnia was found in 20 patients; depression via PHQ-9 in 21 patients, via HADS-D in 5 patients, and anxiety via HADS-A in 12 patients. All of them were evaluated by a psychiatrist at the moment of the symptoms; 7 (21.8%) started psychotropic drugs. After 12 weeks of follow-up, PHQ-9, ISI, HADS-A, and HADS-D decreased, with a p-value ≤ 0.05. Conclusions: NPAEs seem to improve after switching to a DRV/c- or DOR-based regimen after the first 4 and 12 weeks.

The prevalence and moderating factors of sleep disturbances in people living with HIV: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to investigate the prevalence of self-reported sleep disturbances in people living with HIV considering the effects of age, depression, anxiety, CD4 cell counts, time since HIV diagnosis, study region, and the instruments used to measure sleep disturbances. We searched PubMed, PsycINFO, and EMBASE to include eligible articles. In this meta-analysis of 43 studies, the pooled prevalence of self-reported sleep disturbances was 52.29% (95% confidence interval 47.69-56.87). The subgroup analyses revealed that variations in the sleep measurements and study region significantly contributed to the observed heterogeneity. In the meta-regression analyses, higher proportions of participants with depression or anxiety and longer times since HIV diagnosis were significantly associated with a higher prevalence of self-reported sleep disturbances after adjusting for mean age. Our findings emphasise the substantial burden of sleep disturbances in people living with HIV and identified comorbid depression and anxiety and the time since HIV diagnosis as significant moderators. These results underscore the importance of considering these factors when designing tailored screening programmes for high-risk patients and implementing early interventions to prevent and mitigate sleep disturbances in people living with HIV.

Shorter total sleep time is associated with lower CD4+/CD8+ T cell ratios in virally suppressed men with HIV

Study Objectives

Although poor sleep quality is associated with lower CD4+ T cell counts among people living with HIV (PLWH), the association between objective sleep metrics and T lymphocyte subset counts is unknown. We evaluated the association between polysomnography (PSG) derived sleep metrics and T lymphocyte subpopulations in a cohort of men living with HIV.

Methods

Virally suppressed men living with HIV participating in the Multicenter AIDS Cohort Study underwent home overnight PSG. We assessed the association of PSG parameters with CD4+ and CD8+ T cell counts and the CD4+/CD8+ T cell ratio.

Results

Overall, 289 men with mean (±SD) age 55.3 ± 11.3 years and mean CD4+ T cell count 730 ± 308 cells/mm3 were evaluated. Total sleep time (TST) was significantly associated with CD8+ but not CD4+ T cell counts. After adjusting for age, race, depressive symptoms, antidepressant use, and non-nucleoside reverse transcriptase inhibitors use, every hour of shorter TST was associated with an additional 33 circulating CD8+ T cells/mm3 (p = 0.05) and a 5.6% (p = 0.0007) decline in CD4+/CD8+ T cell ratio. In adjusted models, every hour of shorter rapid eye movement (REM) sleep was associated with an additional 113 CD8+ T cells/mm3 (p = 0.02) and a 15.1% lower CD4+/CD8+ T cell ratio (p = 0.006). In contrast, measures of sleep efficiency and sleep-disordered breathing were not associated with differences in T lymphocyte subpopulations.

Conclusions

Our findings suggest that shorter TST and REM sleep durations are associated with differences in T lymphocyte subpopulations among men living with HIV. Addressing sleep may reflect a novel opportunity to improve immune function in PLWH.

Prevalence and Risk Factors for Poor Sleep Quality in People Living with HIV: Preliminary Observations from an HIV Outpatient Clinic

INTRODUCTION

Sleep disorders have been reported in individuals living with HIV (PLWH), with a prevalence rate of over 50%. The main risk factors contributing to the development of sleep disturbances are not yet fully understood. We investigate the prevalence and risk factors associated with poor sleep quality in a population of PLWH who are receiving antiretroviral therapy (ART).

METHODS

The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality in PLWH attending our HIV Outpatient Clinic between October 2022 and April 2023. All subjects with a PSQI score > 5 were considered bad sleepers. A logistic regression analysis was carried out to assess risk factors associated with a PSQI score > 5.

RESULTS

A total of 132 PLWH (78% males) who received ART for at least one month were included in this observational study. The median age was 56 (IQR 47-61). Among all, 41 (31%) had a history of AIDS, and 95 (72%) were receiving an INSTI-based ART. The study population was divided into two groups: PSQI ≤ 5 (90; 68.2%) and PSQI > 5 (42; 31.8%). A lower BMI and the use of bictegravir in the current ART were associated with a PSQI score ≤ 5. In the multivariate analysis, the use of a bictegravir-based ART remained the only factor associated with better sleep quality (OR 0.17; p = 0.0222). No further associations between sleep disturbances and other epidemiological and clinical features were found.

CONCLUSION

In this real-life scenario, poor sleep quality was observed in 31% of the cases, primarily among individuals with higher BMI. In addition, bictegravir users might seem to have a lower likelihood of experiencing poor sleep quality.