Half of adults in HIV group have insomnia--fewer than half of them treated
22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018


Mark Mascolini

Half of adults in a New York City HIV group had insomnia, but fewer than half of them took an insomnia medication [1]. Psychiatric diagnoses proved more frequent in people with insomnia.

Estimated insomnia prevalence with HIV reached 58% in a 9246-person meta-analysis [2], and some research indicates higher prevalence with than without HIV infection. The New York analysis tapped baseline data from a study of mindfulness training and chronic inflammation in HIV-positive adults 45 or older (
NCT02626949).

Researchers from Mount Sinai School of Medicine classified study participants as having or not have insomnia at baseline based on health-record diagnosis or prescription for insomnia. Participants used standard tests to self-report depression (Beck Depression Inventory-II), anxiety (PROMIS-Anxiety Short Form), and fatigue (PROMIS-Fatigue Short Form).

The analysis involved 84 people averaging 58.2 years in age (standard deviation 6.7). Most participants (56%) were men, 57% black, and 33% Hispanic. Median CD4 count stood at 536, and everyone had a viral load below 48 copies.

Forty-three of 84 people
(51%) had insomnia, and insomnia status did not differ by age, sex, race/ethnicity, CD4 count, or treatment with efavirenz. Nor did having insomnia reflect scores for depression, anxiety, or fatigue.

But having a DSM-5 psychiatric diagnosis in the medical record did affect insomnia status.
Sixty of 84 people (71%) had such a diagnosis, and a psychiatric diagnosis was more prevalent in people with than without insomnia (81% versus 61%, P = 0.038). Among people with insomnia, the most frequent psychiatric diagnoses were depression (54%), anxiety (23%), and bipolar disorder (14%). Previous research supports the link between insomnia and psychiatric diagnoses, particularly depression [3].

Among 43 people with study-defined insomnia, only 20 (46.5%) had a prescription for an insomnia medication.

The Mount Sinai team called for research on treating insomnia in people with HIV. They noted that high medication burden in many HIV-positive people suggests that nonpharmacologic interventions like mindfulness training merit special attention.

References

1. Oster S, Barbosa P, Prieto S, Bloom P, Fierer D, Weiss J. Prevalence and treatment of insomnia in persons with HIV well engaged in medical care. AIDS 2018: 22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018. Abstract TUPEB078. https://programme.aids2018.org//PAGMaterial/eposters/7871.pdf
2. Wu J, Wu H, Lu C, Guo L, Li P. Self-reported sleep disturbances in HIV-infected people: a meta-analysis of prevalence and moderators. Sleep Med. 2015;16:901-907.
3. Rogers BG, Lee JS, Bainter SA, Bedoya CA, Pinkston M, Safren SA. A multilevel examination of sleep, depression, and quality of life in people living with HIV/AIDS. J Health Psychol. 2018:1359105318765632. doi 10.1177/1359105318765632. Epub ahead of print.