Researchers say that bad sleep, frequently overlooked in routine HIV care, may well be the missing vital sign that determines how long and how well people with HIV will live, and that disrupted sleep patterns are widespread among those infected with the virus, even if they are virally suppressed, reports TimesLIVE.
According to the study led by Wits University and published in The Lancet HIV, poor sleep is a widespread issue among those who are HIV+, and significantly increases the risk of heart disease, depression and cognitive decline, ultimately shortening the span of healthy life.
The study highlights how sleep quality remains largely neglected in HIV care, particularly in South Africa.
“Despite how common poor sleep is among people with HIV, most healthcare providers don’t routinely ask patients about their sleep,” said Professor 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 added.
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.
Associate Professor Karine Scheuermaier, head of the Wits Sleep Lab within the brain function research group, these sleep disturbances often present differently.
“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 with HIV:
• Inflammation and immune activation;
• Treatment side-effects; and
• Circadian misalignment.
The latter, they said, may result from HIV-related proteins such as Tat that can delay the body’s natural circadian clock.
Scheuermaier said sleep disorders are often seen as peripheral to HIV management but addressing them could yield wide-ranging health benefits, and reduce cardiovascular risk, and improve mood and strengthen treatment adherence, which are core outcomes in chronic care.
Call to action for clinicians
The study proposes a practical screening pathway that can be applied even outside specialised sleep clinics.
• Use brief screening tools such as the Pittsburgh sleep quality Index, insomnia severity index, or Stop-Bang questionnaire for apnoea risk.
• Identify and address modifiable factors like 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.
Study details
Understanding and managing disordered sleep in people with HIV
Luxsena Sukumaran, Karine Scheuermaier, Caroline Sabin, et al.
Published in The Lancet HIV on 23 September 2025
Summary
People with HIV experience higher burden of cardiometabolic, mood, and cognitive disorders. Poor-quality and insufficient sleep are both associated with increased risk for these comorbidities and are more common in people with HIV. Although previous reviews have explored the prevalence and risk factors for sleep complaints in people with HIV, few have differentiated these complaints by potential underlying causes. Disordered sleep in people with HIV might arise from HIV-specific sleep disruptors, including direct effects of the virus, chronic inflammation, and antiretroviral treatment. There is also evidence that sleep is more fragile in people with HIV and some common sleep disorders, such as obstructive sleep apnoea, chronic insomnia, and circadian rhythm disorders, might be particularly problematic in people with HIV. Understanding how HIV uniquely disrupts sleep physiology could inform the development of tailored, mechanism-based management strategies to improve sleep health in people with HIV.
TimesLIVE article – Poor sleep steals years from people living with HIV (Restricted access)
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