Efficacy of Non‐Pharmacological Interventions in Improving Health‐Related Quality of Life in People Living With HIV : A Bayesian Network Meta‐Analysis of Randomized Controlled Trials

BACKGROUND: With antiretroviral therapy, HIV has become a manageable chronic condition, shifting focus to improving health-related quality of life (HRQoL). Non-pharmacological interventions offer distinct advantages for optimizing long-term health outcomes in people living with HIV. OBJECTIVES: To identify optimal non-pharmacological interventions for improving overall HRQoL and its domains (physical, psychological, social, environmental, independence, spiritual). METHODS: Ten databases (Embase, MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, CENTRAL, CBM, CNKI, VIP Information, Wanfang Data) were searched from inception to August 2025. Bayesian network meta-analyzes were performed for direct and indirect comparisons. The Cochrane Rob-2 and the CINeMA tools were used to assess risk of bias and the certainty of evidence, respectively. RESULTS: 37 articles were included. Exercise was most effective for overall HRQoL (SMD = 1.00, 95% CI [0.43, 1.58]) and physical (SMD = 0.69, 95% CI [0.11, 1.27]), psychological (SMD = 0.93, 95% CI [0.37, 1.51]), and social (SMD = 0.57, 95% CI [0.06, 1.08]) domains. Mindfulness-based interventions ranked second for overall HRQoL (SMD = 0.82, 95% CI [0.24, 1.40]). Cognitive behavioral therapy ranked second in the psychological domain (SMD = 0.73, 95% CI [0.16, 1.29]). Insufficient data precluded network meta-analysis for environmental, independence, and spiritual domains. LINKING EVIDENCE TO ACTION: Future research should explore how different exercise types affect specific HRQoL dimensions and conduct large-scale, head-to-head RCTs to confirm the efficacy of exercise, cognitive behavioral therapy, and mindfulness interventions, especially for the environmental, independence, and spiritual domains. Methodological improvements-including blinding of outcome assessors, intention-to-treat analysis, standardized measurement tools, and protocol transparent reporting-are needed. TRIAL REGISTRATION: PROSPERO: CRD420251118087.