Patients with HIV infection exhibit different circadian rhythms than those without the disease, including more delayed, interrupted, and less robust sleep patterns. These findings were published in Open Forum Infectious Diseases.
Sleep disturbances are common among patients with HIV and may contribute to the risk and severity of non-AIDS-related comorbidities.
Investigators at the University of Pittsburgh in Pennsylvania recruited adults with and without HIV between 2018 and 2022 to compare their sleep patterns and rest-activity rhythms. Patients with HIV who had CD4+ counts above 200 cells/µL and had been virologically suppressed on antiretroviral therapy for at least 1 year were matched against those without HIV by age and sex. All patients were given a wrist-worn device to capture actigraphy-derived sleep metrics and kept a sleep diary for 14 consecutive days.
Multivariable linear and logistic regression models were employed for statistical analysis and were adjusted for sociodemographic factors and peripheral apnea-hypopnea index measurements. One-way analysis of variance and chi-squared testing were used to determine between-group differences in sleep and rest-activity rhythm metrics.
Among patients with (n=106) and without (n=105) HIV infection, the mean (SD) ages were 55.7 (10.2) and 57.5 (11.7) years, 24% and 27% were women, 43% and 24% were non-Hispanic Black, the mean BMI was 28.1 (6.7) and 27.1 (4.6) kg/m2, 36% and 21% were current smokers, and the mean number of peripheral apnea-hypopnea index events per hour was 11.3 and 6.6, respectively.
Compared with those without HIV, patients with HIV had significantly lower sleep efficiency rates (mean difference [MD], -3.9%; P <.0001), longer sleep latency (MD, 3.4 minutes; P =.004), longer wake times after sleep onset (MD, 13.4 minutes; P =.006), and longer daily nap durations (MD, 11.0 minutes; P =.003). Positive HIV status was also associated with later self-reported bed time (MD, 38.6 minutes; P =.006), later sleep midpoint (MD, 43.6 minutes; P =.007), and later wake times (MD, 42.6 minutes; P =.002).
Further analysis of actigraphy-derived metrics indicated no between-group differences in the intensity of physical activity, suggesting sleep patterns were independent of the level of physical activity. Overall, patients with HIV showed less consistent sleep patterns and less robust daily activity patterns than those without disease, including in adjusted analyses.
These trends were replicated in sensitivity analyses that excluded individuals who reported use of efavirenz.
Study limitations include the lack of assessment for physiologic circadian markers such as dim-light melatonin onset or core body temperature, the lack of validated quantitative measures of physical activity, and potential lack of generalizability to women.
The investigators concluded, “[A]dvancing and increasing the robustness of circadian rhythms may be a novel intervention to reduce the risk of non-AIDS comorbidities among PLWH [people living with HIV].”
By Jessica Nye, PhD
References:
Borker PV, Smagula SF, Sherman J, Morris A, Macatangay B, Patel SR. Sleep and rest-activity rhythms are delayed and less robust in people living with HIV. Open Forum Infect Dis. Published online August 21, 2025. doi:10.1093/ofid/ofaf498
Source : Infectious Disease Advisor