The authors searched ten databases (Embase, MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, CENTRAL, CBM, CNKI, VIP Information, and Wanfang Data) from inception to August 2025 to identify randomized controlled trials of non-pharmacological interventions targeting health-related quality of life (HRQoL) in people living with HIV. The review included 37 eligible RCTs. A flow diagram of study selection is provided in the full text.
A Bayesian network meta-analysis framework was used to synthesize direct and indirect comparisons across intervention types. The Cochrane RoB-2 tool assessed risk of bias for individual trials, and CINeMA was applied to evaluate the certainty of evidence for network estimates. The authors present network plots and forest plots to summarize pooled standardized mean differences (SMDs) and 95% confidence intervals for overall HRQoL and predefined domains.
Included trials evaluated multiple non-pharmacological approaches. Intervention categories represented in network plots and analyses include exercise interventions, mindfulness-based interventions (MBI), cognitive behavioral therapy (CBT), counseling, case management, mind–body therapy, motivational interviewing, psychoeducation, social support, and non-intervention comparators. The exact counts of trials per intervention type are reported in the article figures and supplementary material.
For the primary outcome of overall HRQoL, exercise interventions ranked highest in the network meta-analysis. Exercise produced a statistically significant and clinically relevant pooled effect versus non-intervention with an SMD of 1.00 (95% CI 0.43 to 1.58). Mindfulness-based interventions were the next-best ranked intervention for overall HRQoL, with an SMD of 0.82 (95% CI 0.24 to 1.40).
These estimates derive from network pooling of direct and indirect comparisons across the included randomized trials. The authors present SUCRA-based rankings and forest plots to illustrate comparative performance.
Physical domain: Exercise again ranked highest for the physical domain of HRQoL, with a pooled SMD of 0.69 (95% CI 0.11 to 1.27) compared with non-intervention.
Psychological domain: Exercise showed a strong effect on psychological HRQoL (SMD 0.93, 95% CI 0.37 to 1.51). Cognitive behavioral therapy was the second-ranked approach for psychological outcomes (SMD 0.73, 95% CI 0.16 to 1.29).
Social domain: Exercise achieved the top ranking for the social domain as well (SMD 0.57, 95% CI 0.06 to 1.08).
These domain-specific estimates come from the network meta-analytic models; forest and network plots for each domain are provided in the publication.
The authors report that data were insufficient to construct network meta-analyses for the environmental, independence, and spiritual domains. For these domains, only traditional pairwise meta-analyses were possible, and network estimates were not produced. Specific pooled estimates for those domains from pairwise analyses are presented in the full article where available.
Risk of bias across included trials was assessed with the Cochrane RoB-2 tool. The certainty of network estimates was judged using CINeMA. The authors note the need for methodological improvements in future trials, including blinded outcome assessment, intention-to-treat analyses, standardized outcome measures, and transparent protocol reporting to strengthen confidence in effect estimates.
Based on the network meta-analysis, exercise interventions appear most effective for improving overall HRQoL and the physical, psychological, and social domains in people living with HIV. Mindfulness-based interventions also showed meaningful benefit for overall HRQoL, and CBT ranked highly for psychological outcomes.
The authors recommend that future research address remaining gaps by:
These steps are proposed to confirm the relative efficacy of interventions and to extend evidence into the environmental, independence, and spiritual domains.
The systematic review and network meta-analysis were registered in PROSPERO (CRD420251118087). The authors declared no conflicts of interest in the publication.
Note: This summary reports only results and details provided in the source abstract and article metadata. For full numeric tables, trial-level characteristics, and extended methods, refer to the published article (Worldviews Evid Based Nurs. 2026;23[4]:e70167; DOI: 10.1111/wvn.70167).