Our objective was to determine the correlation between cytokines levels and ART and insomnia in HIV+ women.

Immune dysregulation are known to be involved in CNS dysregulation of physiological sleep.   It is also known that HIV+ patients using antiretroviral therapy (ART) may experience insomnia as a side-effect of the medication itself.

Retrospective study nested in the Hispanic Longitudinal cohort using stored data, and plasma and CSF of 27 infected women.  Two groups: 5 in Protease inhibitors (PI)  and 22 in dual therapy with PI and nucleoside reverse transcriptase inhibitors (NRTI). Insomnia was determined with the ATHENA scale.  Plasma and CSF cytokines with flow cytometry.  

All patients on the PI group show sleep disturbances. However, 60% of patient in coadministration regime with PI and NRTI, showed insomnia. Plasma interleukin-1 receptor antagonist (IL-1RA) was significantly higher in HIV+ with insomnia. Our study was limited due to unavailability of data to compare patients on single therapy with PI and insomnia versus not sleep dysregulation. No significant difference was observed in plasma and CSF IL-1RA levels between patient with insomnia on single therapy with PI and coadministration of PI and NRTI.

We propose that higher plasma IL-1RA levels in those who subsequently develop insomnia reflect the host’s homeostatic mechanism aimed at downregulating pre-existing inflammation. IL-1RA is stimulated by circulating inflammatory mediators . Moreover, it has been postulated that circulating IL-1RA during inflammatory stress may serve to reduce the systemic responses. Note that serum levels of IL-1RA have been found higher in depressed patients than in controls, as well as increased levels of IL-1RA correlates with the severity of depression symptoms. Thus, our study extends the evidence that systemic IL-1RA levels are upregulated in patients with HIV-infected and insomnia. This may result in sleep dysfunction, possibly affecting share biological pathways among inflammation, depression, and insomnia.