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With antiretroviral therapy, HIV has become a manageable chronic condition, shifting focus to improving health-related quality of life (HRQoL). Non-pharmacological interventions offer distinct advantages for optimizing long-term health outcomes in people living with HIV.
To identify optimal non-pharmacological interventions for improving overall HRQoL and its domains (physical, psychological, social, environmental, independence, spiritual).
Ten databases (Embase, MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, CENTRAL, CBM, CNKI, VIP Information, Wanfang Data) were searched from inception to August 2025. Bayesian network meta-analyzes were performed for direct and indirect comparisons. The Cochrane Rob-2 and the CINeMA tools were used to assess risk of bias and the certainty of evidence, respectively.
37 articles were included. Exercise was most effective for overall HRQoL (SMD = 1.00, 95% CI [0.43, 1.58]) and physical (SMD = 0.69, 95% CI [0.11, 1.27]), psychological (SMD = 0.93, 95% CI [0.37, 1.51]), and social (SMD = 0.57, 95% CI [0.06, 1.08]) domains. Mindfulness-based interventions ranked second for overall HRQoL (SMD = 0.82, 95% CI [0.24, 1.40]). Cognitive behavioral therapy ranked second in the psychological domain (SMD = 0.73, 95% CI [0.16, 1.29]). Insufficient data precluded network meta-analysis for environmental, independence, and spiritual domains.
Future research should explore how different exercise types affect specific HRQoL dimensions and conduct large-scale, head-to-head RCTs to confirm the efficacy of exercise, cognitive behavioral therapy, and mindfulness interventions, especially for the environmental, independence, and spiritual domains. Methodological improvements—including blinding of outcome assessors, intention-to-treat analysis, standardized measurement tools, and protocol transparent reporting—are needed.
PROSPERO: CRD420251118087
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