title: Insomnia in HIV infection: a systematic review of prevalence, correlates, and management.
abstract: OBJECTIVE
  Insomnia in people with HIV and AIDS has been widely but inconsistently reported. We present the results of a systematic review of the subject.
  
  
  METHODS
  MEDLINE, EMBASE, PSYCHLIT, and CINAHL databases were searched, and inclusion criteria were applied. The study results were then collated and described.
  
  
  RESULTS
  Twenty-nine studies were identified, and there was wide variation in both method and quality. Insomnia was reported frequently and at all stages of HIV infection. Early reports of sleep-specific electroencephalographic changes were not confirmed. The role of immune dysregulation, virus progression, and adverse drug effects in contributing to insomnia is unclear. The presence of cognitive impairment, an AIDS-defining illness, and treatment with efavirenz were found to be significant risk factors, but the most notable association was with psychologic morbidity. There was limited evidence for the effect of specific treatments for insomnia in HIV infection.
  
  
  CONCLUSIONS
  This review found that psychologic morbidity was a major determinant of insomnia in HIV infection. Further study would be of value in clarifying the role of other factors, as well as measuring the impact of insomnia on functioning and quality of life in this population.
authors.affiliation: Department of Psychological Medicine, Imperial College, London, UK. steve.reid@nhs.net
authors.forename: Steven
authors.initials: S
authors.lastname: Reid
authors.forename: Justin
authors.initials: J
authors.lastname: Dwyer
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D019992:Databases as Topic / Q000706:statistics & numerical data; D004569:Electroencephalography / Q000706:statistics & numerical data; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D017286:Polysomnography; D015995:Prevalence; D011788:Quality of Life; D012107:Research Design / Q000592:standards; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents