Sleep Disturbances and Circadian Phase Delay in People Living with Human Immunodeficiency Virus (HIV): A Systematic Review

Advances in HIV research and antiretroviral therapy (ART) have substantially increased life expectancy among people living with HIV (PLHIV). However, challenges affecting quality of life and alterations in daily physiological processes persist. Among the health dimensions most affected are sleep quality and circadian rhythms, resulting in significant biological alterations. The main objective of this study is to analyze the existing scientific evidence regarding the effects of HIV on sleep quality and on the alignment and synchronization of circadian rhythms. The bidirectional interaction between these physiological alterations and associated clinical, immunological, and metabolic factors in people living with HIV (PLHIV) was evaluated, emphasizing their integration. For this review, searches were conducted in the PubMed, Scopus, and Web of Science databases. Eligibility criteria were applied, resulting in a final selection of 15 studies based on search strategies. The findings demonstrated a high prevalence of poor sleep quality as well as delayed circadian phase. These chronobiological alterations were closely associated with systemic inflammation, altered melatonin levels, impaired cognitive performance, and an altered metabolic profile involving leptin, ghrelin, adiponectin, and peroxisome proliferator-activated receptor (PPAR) signaling. Despite the consistency of the results, the methodologies of individual studies varied, and a notable absence of clinical trials aimed at addressing poor sleep quality and chronodisruption was observed. A promising clinical approach involves complementing antiretroviral therapy (ART) with chronotherapeutic interventions and sleep hygiene. In conclusion, HIV can disrupt personal temporal organization at a systemic level; consequently, incorporating assessments of sleep and circadian rhythms into clinical care may be warranted, while chronotherapeutic interventions should be further investigated.