Medical advancements in antiretroviral therapy (ART) have transformed HIV from a fatal disease to a manageable chronic illness. HIV’s global incidence has decreased by almost 40% since 2010, and HIV- and AIDS-related deaths have decreased by almost 54% [1]. Additionally, with improvements along the HIV care continuum, HIV incidence is decreasing while HIV prevalence is on the rise [2]. As of 2024, the estimated number of people with HIV globally has increased to 40 million [3], predominantly because people with HIV are living longer and healthier lives. People with HIV are now expected to have life expectancies similar to those of their HIV-negative peers, representing a substantial increase from the estimated 2-year life expectancy following an HIV diagnosis in the 1980s [4]. Although the greatest global burden of HIV is concentrated in sub-Saharan Africa [3,5], the United States and other high-income countries continue to experience a persistent HIV epidemic because of intersecting epidemics of mental health conditions, stigma, and substance use among populations such as men who have sex with men, people who use injection drugs, and sex workers [6].

With HIV’s transition to a chronic condition, the focus of HIV-related research and care has gradually shifted from one primarily focused on reducing mortality to one that is concerned with addressing comorbid physical and psychological conditions experienced by people with HIV. One area that is particularly important to consider when exploring health-related quality of life among people with HIV is sleep. Compared with their age-matched peers, people with HIV are disproportionately burdened by sleep-related disorders [7] and show a higher prevalence of poor sleep quality, with estimates ranging from 24.1% to 100% compared with 10% to 40% in the general population [8]. The most common sleep-related disorders reported by people with HIV are insomnia and obstructive sleep apnea (OSA), with rates reaching as high as 35% for insomnia [9] and up to 75% for OSA [10], depending on the sample and setting. Chronic sleep disruption itself has been associated with greater depressive symptoms, anxiety, and substance use [11-13]; increased inflammatory responses [14]; and increased cardiovascular disease risk [15-19]. Among people with HIV, sleep disturbances have been associated with increased mental health burden [8,20], higher incidence of antiretroviral nonadherence [8,21], and the presence of other medical comorbidities that diminish quality of life [22]. The sequelae of health conditions resulting from poor sleep among people with HIV are uniquely challenging given the bidirectional impact between sleep disturbances and HIV disease severity. For example, sleep has a strong influence on one’s virologic control, which in turn may compromise the efficacy of ART in fully suppressing HIV [23,24]. Conversely, certain ART medications use may impact sleep architecture and lead to increased sleep fragmentation among people with HIV [22].

Sleep disturbances among people with HIV are multifactorial and should be examined within a biopsychosocial framework [25,26]. At the biological level, the HIV retrovirus impacts the immune system in several ways. When left untreated, HIV depletes an individual’s CD4+ T lymphocytes, significantly hampering a person’s ability to fight off infection [22]. Over time, chronic immune activation driven by persistent proinflammatory markers continues to alter immune functioning within both virally suppressed and unsuppressed people with HIV [27]. Although the direct pathophysiological basis of sleep and HIV is not fully understood, poor sleep itself has been implicated in the dysregulation of inflammatory and antiviral responses, which may further impact overall immune functioning among people with HIV [22,28]. Psychologically, people with HIV experience elevated levels of depression, anxiety, stigma-related stress, and chronic pain, all of which may be associated with reduced sleep quality and diminished quality of life [29-32]. Psychological comorbidity has been found to be a determinant of insomnia among people with HIV [33]. Finally, social factors such as economic marginalization, housing insecurity, and limited access to health care further contribute to sleep disturbances among people with HIV [34]. Importantly, these factors do not operate in isolation but compound one another and create a negative reinforcing cycle that further perpetuates sleep dysregulation [26,32,34].

Fortunately, there are several evidence-based treatments to reduce insomnia symptoms and improve overall sleep quality. Cognitive behavioral therapy for insomnia (CBT-I) is the frontline nonpharmacological intervention for treating insomnia [35] because of its direct effects on sleep onset latency, wake time after sleep onset, and sleep efficiency [36,37]. Additional interventions include mindfulness and relaxation-based interventions, exercise and lifestyle interventions, and chronotherapy, which uses light exposure to regulate the body’s natural circadian rhythm [37,38]. Mind-body interventions for insomnia and sleep disorders may include yoga, acupuncture, aromatherapy, meditation, and siloed sleep hygiene education or stimulus control procedures [37,38]. Although these stand-alone interventions may help to reduce insomnia symptoms, the evidence indicates that the strongest improvements occur when these interventions are combined with a comprehensive CBT-I approach [37].

In addition to nonpharmacological interventions for treating insomnia, there are several pharmacotherapy approaches also used to improve sleep. Medications such as benzodiazepines, nonbenzodiazepine hypnotic medications, orexin receptor antagonists, melatonin receptor agonists, certain antidepressants, and antihistamines [37,38] are commonly used to improve sleep among people with acute or chronic insomnia [37]. These medications primarily function by shortening sleep latency and increasing the overall duration of time asleep; however, long-term use is discouraged due to concerns regarding adverse effects [37]. Although research suggests that pharmacological interventions for insomnia are as effective as CBT-I for improving insomnia in the short term, patients who receive CBT-I demonstrate more robust long-term sleep benefits compared with those who received only pharmacological treatment [39,40].

Despite ample literature highlighting the efficacy of both nonpharmacological and pharmacological approaches to treating insomnia and poor sleep quality in the general population, little is known about sleep-focused interventions designed for and tested among people with HIV. Although several randomized controlled trials have evaluated tailored behavioral or pharmacologic sleep interventions among people with HIV, most have targeted downstream comorbidities, rather than directly addressing sleep disorders as primary treatment targets [41]. This is particularly concerning given the elevated rates of insomnia and sleep disturbances among people with HIV and the urgent need for more personalized precision medicine approaches to treating insomnia in this more medically complex population. Furthermore, although there have been a couple of reviews [24,42] examining interventions to improve sleep among people with HIV, they likely miss potentially relevant work due to their narrow scope. This scoping review aims to address the limitations of the prior systematic reviews by including research that (1) explores both pharmacological and nonpharmacological interventions to improve sleep among people with HIV; (2) reflects the experiences of people with HIV with medical comorbidities, including OSA, due to the high comorbidity of not only HIV and other medical conditions but also insomnia and OSA; (3) is published in any language (not just English or Chinese); and (4) can be found in a wider array of indexed databases and gray literature sources. In addition, this study includes data published between 2022 and July 2026 to capture more recent evidence that would not have been included in prior reviews [24,42]. As such, these gaps in the larger literature provide a strong rationale for our scoping review of both pharmacological and nonpharmacological interventions for treating insomnia symptoms and poor sleep quality among people with HIV across the life course.

The scoping review will follow the JBI scoping review methodology, as described by Peters et al [43], and adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting standards [44]. This protocol is also registered in OSF Registries (UHGC7).

As of July 10, 2026, a total of 4270 potentially eligible unique titles and abstracts have been identified by a search of the predefined databases and registries (eg, MEDLINE and Embase) and imported into Covidence (refer to Figure 1 for the proposed PRISMA flowchart). Authors anticipate that relevant full texts will be identified by December 2026, and all eligible manuscripts will be initially reviewed by January 2027. Final results are expected to be consolidated and submitted for publication in the spring or summer of 2027. Although no specific funding was used for study procedures, some author time (ERW) was supported by the National Institute of Allergy and Infectious Diseases (T32AI007433).

This scoping review will provide an overview of the evidence-based pharmacological and nonpharmacological interventions that exist to address insomnia and sleep-related disorders among people with HIV. Current reviews of sleep interventions targeting people with HIV are limited and often do not include sleep as a primary outcome in interventions, solely focus on nonpharmacological interventions to treat insomnia symptoms and poor sleep, or primarily focus on studies published in English [24,42,46,47]. By identifying both currently available pharmacological and nonpharmacological insomnia treatments that have been developed and tested among people with HIV and the interventions that are most effective for this population, we may help behavioral health care clinicians and/or sleep medicine physicians deliver insomnia treatment consistent with precision behavioral medicine. This approach involves individualized assessment and personalized sequencing of behavioral treatment modules based on patients’ unique needs and may improve the effectiveness of pharmacological and nonpharmacological interventions for reducing sleep-related morbidity among people with HIV. By centering sleep as a primary clinical concern, this review may encourage more integrated, multidisciplinary strategies to address sleep disturbances directly rather than as a secondary consideration. Overall, we hypothesize that (1) few studies will be identified that specifically outline either pharmacological or nonpharmacological interventions that have been tested among people with HIV and (2) should such studies be identified, most will center on applications of CBT-I or common hypnotics and selective serotonin reuptake inhibitors most typically used to treat insomnia.

This scoping review has several anticipated limitations. Heterogeneity in study design, intervention type, and outcome measures may limit the ability to standardize comparisons across studies. These nuances may limit the strength and generalizability of the conclusions drawn from this scoping review. Additionally, variability in how sleep outcomes are defined and measured, particularly with regard to self-reported metrics, may introduce inconsistencies in the interpretation of findings. Finally, because sleep is so often assessed as a secondary outcome in HIV-related interventions, relevant studies may vary in the depth and scope with which sleep outcomes are reported and discussed.