Poor Sleep Decreases Antiretroviral Adherence In People With HIV
Published: Sep 2, 2011 9:40 am; Updated: Sep 8, 2011 10:53 am
Results from a recent study indicate that people with HIV who have trouble falling asleep or staying asleep are significantly less likely to adhere to their antiretroviral therapy regimens.
The authors of the study suggested that clinicians look for and promptly treat sleep difficulties in HIV-positive individuals, which may increase adherence to antiretroviral therapy.
”It is important for health care providers to engage in a discussion about sleep difficulties with their patients,” said Dr. Parya Saberi, the study’s lead investigator and an assistant clinical professor at the University of California, San Francisco, in correspondence with The AIDS Beacon.
“This may help facilitate the discussion about other issues that may be associated with poor sleep quality, such as depression, suicidal ideation, and drug use,” she added.
She pointed out that HIV-positive individuals experiencing sleep problems can use sleeping medications or aids at lower doses. “Sleep aids are not known to increase or decrease the effect of antiretrovirals,” she explained.
Previous studies indicate that over 70 percent of HIV-positive individuals report sleep disturbances at some point, compared to 10 percent to 35 percent of the general population.
Sleep disturbances can cause difficulties with attention, concentration, fatigue, and memory impairment. In addition, sleep problems may increase the risk for car accidents, diabetes, psychiatric disorders, and heart problems.
According to the study authors, there are few studies that have investigated the effect of poor sleep on the health of people with HIV, particularly their adherence to antiretroviral therapy.
Lack of adherence to therapy may result in treatment failure, disease progression, or the development of HIV strains that are resistant to current drug therapies.
In this study, researchers investigated the relationship between poor quality of sleep and antiretroviral therapy drug adherence in 2,845 HIV-positive patients.
The authors assessed quality of sleep with a questionnaire regarding sleep patterns, amount of difficulty falling or staying asleep, and problems with vivid dreams.
Results showed that 68 percent of study participants reported sleep pattern changes, 50 percent reported difficulty falling or staying asleep, and 21 percent reported problems with vivid dreams.
In addition, depression, suicidal thoughts, unemployment, drug abuse, history of incarceration, and high HIV viral loads (amount of HIV in the blood) were associated with poor quality of sleep.
Participants taking Sustiva (efavirenz) were more than two times more likely to report problems with vivid dreams, which are a known side effect of the drug; however, this was not associated with overall poorer quality of sleep.
Results also showed that individuals who were homosexual, bisexual, or of Latino ethnicity had a 26 percent, 56 percent, and 37 percent higher chance of sleep disturbances, respectively.
Sleep pattern changes and sleep problems were significantly associated with antiretroviral therapy non-adherence.
Individuals who woke up several hours earlier than they used to and could not go back to sleep had a 66 percent higher chance of non-adherence compared to study participants who slept normally. Individuals who had experienced problems falling or staying asleep or problems with vivid dreams in the past three months had a 42 percent and 31 percent higher chance of non-adherence, respectively.
Results also showed that depression, having ever lived in a shelter, suicidal thoughts, and drug abuse were associated with non-adherence. African-Americans were 35 percent more likely to not adhere to therapy compared to Caucasians, and there was a 20 percent higher chance of non-adherence with every 10 year decrease in age.
For more information, please see the study in AIDS Patient Care and STDs.
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