Poor sleep steals years from people living with HIV

Sleep, often overlooked in routine HIV care, could be the missing vital sign that determines how long and how well people living with HIV (PLHIV) live, according to a new study by Wits University researchers.

Published in The Lancet HIV and titled “Understanding and Managing Disordered Sleep in People Living with HIV”, the study reveals disrupted sleep is widespread among PLHIV, even in those who are virally suppressed. This, researchers warn, significantly increases the risk of heart disease, depression and cognitive decline, ultimately shortening the span of healthy life.

South Africa, home to about eight million people living with HIV, faces a particularly urgent challenge as the study highlights how sleep quality remains largely neglected in HIV care.

“Despite how common poor sleep in people living with HIV is, most healthcare providers don’t routinely ask patients about their sleep,” said Prof Xavier Gomez-Olivé, an associate professor at the South African Medical Research Council/Wits rural public health and health transitions research unit (Agincourt) and one of the study’s contributing authors.

“This leaves a major gap in care that affects daily functioning and long-term health. Poor sleep undermines everything else, immunity, cognition, mental health and treatment adherence,” he said.

Gomez-Olivé said while clinicians routinely check viral load and blood pressure, few assess how well their patients are sleeping, despite mounting evidence that disordered sleep can erode overall health and quality of life.

Fragmented and ‘unsatisfying’ sleep

According to associate Prof Karine Scheuermaier, head of the Wits sleep lab within the brain function research group, sleep disturbances among PLHIV often present differently.

“We see it is fragmented, light and unsatisfying, but still clinically important. Many people with HIV fall into this grey zone so their symptoms go untreated,” she said.

What causes disordered sleep?

The researchers identified three main drivers of disordered sleep in people living with HIV:

• Inflammation and immune activation.
• Treatment side-effects.
• Circadian misalignment.

The latter, they said, may result from HIV-related proteins such as Tat that can delay the body’s natural circadian clock.

“Sleep can’t be separated from mental health or social context. When people live with uncertainty or stress, the body stays on alert and rest becomes difficult,” Gomez-Olivé said.

Scheuermaier stressed sleep disorders are often seen as peripheral to HIV management but addressing them could yield wide-ranging health benefits.

“Addressing them could reduce cardiovascular risk, improve mood and strengthen treatment adherence, all of which are core outcomes in chronic care,” she said.

Call to action for clinicians

The study proposes a practical screening pathway that can be applied even outside specialised sleep clinics.

Clinicians are encouraged to:

• Use brief screening tools such as the Pittsburgh sleep quality Index, insomnia severity index, or Stop-Bang questionnaire for apnea risk.
• Identify and address modifiable factors such as depression, pain, substance use, antiretroviral therapy side-effects and environmental stressors.
• Reassess sleep health periodically as problems can evolve with age, treatment changes and comorbidities.

The researchers said prioritising sleep could not only improve the quality of life for people living with HIV but also strengthen the country’s broader HIV care outcomes.