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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.
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.
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Background on Sleep Disturbances among HIV+ & the damage it causes. Its neglected by researchers: what is its contribution in HIV research to CVD or diabetes, or cognitive impairment? we don't know because its never factored into HIV research studies.
from Jules - Sleep Disturbances in HIV+ has been Neglected for Years. In an older study it was found that (73%) respondents were classified as having a sleep disturbance. I have accumulated lots of this research on the NATAP WEBSITE.
NOW with the aging HIV+ population clearly it is a much more important issue because it can contribute to cognitive impairment, it can contribute to cardiovascular disease, diabetes and immune dysfunction. This is the type of research that needs more attention. The NIH,NIAID, ACRG, and OAR have marginalized & limited how much research Aging in HIV can receive because NIAID & OAR leadership including Tony Fauci who sets the research priorities & who runs everything have decided aging & HIV will not get the funding support needed; thus those working under him who implement this agenda - Carl Dieffenbach at NIAID, Maureen Goodenow at OAR and Rich Wolitski at HHS - will nit give the attention needed for are adequate aging research. Aging HIV+ need better care models, their clinics need funding for this, this funding should be from the Ryan White Care Act which is funded to provide such services; better & broader research into more patient focused issues LIKE THIS STUDY ON INSOMNIA are what is also needed and there are lots more questions LIKE this that require attention but now get NO ATTENTION, including the subject of MITOCHONDRIAL DAMAGE, which is likely a key contributor to premature or accelerated aging in HIV+. This subject received much research attention in the earlier days of HIV to be abandoned now. Researchers might say we do not have any drugs to test that might ameliorate t=mitochondrial damage, and that may be true, but that does not mean we should not be trying to understand this problem more and to try harder to find answers, like how much specific ARTS might contribute to mitochondrial damage & how we might be able to improve or avoid this problem & its relationship to the accelerated aging problem in HIV.
Mitochondria Damage & Aging - (10/09/08)......"It is generally accepted that oxidative mitochondrial decay is a major contributor to aging."Nils-Goran Larsson of the Karolinska Institute in Sweden pinpointed where the process of aging begins in a cell-the mitochondria-and thus where it may be slowed. In their efforts to conquer the aging process, researchers are zeroing in on one specific part of the cell: mitochondria, the energy-generating organelles that control our metabolism and, it seems, help regulate how long we live......Mitochondrial mutations may also underlie Alzheimer's, Parkinson's, and other diseases that are common among senior citizens.....Although mitochondria are certainly not the sole cause of aging, the findings suggest that they exert a surprisingly powerful influence. The discoveries also hint at ways to hold on to youth by altering mitochondrial activity. "If we can find a way to manipulate how they work," Speakman says, "it could well be the new path to powerful life-prolonging drugs."
from the early days in HIV there were many studies finding that HIV+ have sleep disturbances. It is well reported that can affect the immune system and increase risk for comorbidities including heart disease and diabetes, AND OF NOTE COGNITIVE IMPAIRMENT. Here take a look:
Depression Raises Risk of Diabetes, Study Finds The incidence rate of diabetes was 4.4 per 1000 person-years.-
Lack of Sleep Linked to Heart Problems
"CNS infections often lead to hypersomnolence but may also present with insomnia or sleep-wake cycle disruptions....."

High Prevalence of Insomnia in an Outpatient Population With HIV ... www.natap.org/2008/HIV/041108_01.htm....."(73%) respondents were classified as having a sleep disturbance....Anxiety, depression, self-reported sleep disturbance, and signs of cognitive impairment as already defined were significant predictors of insomnia..... One of the most striking findings in our study was that 100% of patients with cognitive impairment had sleep disturbances......"HIV enters the central nervous system (CNS) shortly after initial infection and may involve the brain before onset of any other physical manifestations of the disease (22,23)....CNS infections often lead to hypersomnolence but may also present with insomnia or sleep-wake cycle disruptions
Elevated levels of interferon, tumor necrosis factor, and interleukin-1 (IL-1) have been detected in HIV-seropositive patients (1). These substances have all been shown to affect sleep physiology by enhancing slow wave sleep (SWS) and thereby disrupting normal rapid eye movement and non-rapid eye movement (REM/NREM) sleep cycles (16). Research on animal models also offers support for an immune-mediated association; Fewer than 45% of patients with insomnia, surprisingly, had any mention of sleep disturbance in their clinic records..... clinicians need to be more aware of the high prevalence of insomnia in HIV-seropositive outpatients. Prompt diagnosis and treatment of insomnia may improve quality of life and feelings of well-being in HIV-seropositive ambulatory populations.""
Sleep disturbances in patients with hepatitis C virus infection
HIV & Sleep Disturbances......http://www.natap.org/2012/HIV/050412_06.htm......."On the basis of experimental studies it is known that sleep disturbances are associated with alterations of the immune system.......The alteration of cytokine levels both in the periphery as well as in the brain itself could well be involved in the development of sleep disturbances.