Investigations of lifestyle factors


It is known that several lifestyle factors, including tobacco, alcohol and recreational drug use, are common in PLWH.  Previous analyses of the general population have demonstrated a strong association between these lifestyle factors and condomless sex in young people.  Higher risk sexual activity has also been reported in men who have sex with men living with HIV.  However, it is not known if or how these factors cluster together within older PLWH.

Study aims

Our aims are to investigate the patterns and frequency of multiple risk behaviours (alcohol, drugs, smoking, higher risk sexual activity) among MSM PLWH in POPPY.  We also wished to investigate if there are any clinical associations with this phenotype, particularly regarding associations with mental health problems, or a poorer adherence to ART.

Work to date

We have used the baseline data from PLWH within POPPY only.  Using this information, we identified four key risk behaviours: current smoking, alcohol consumption >21 units per week, recreational drug use in the past 6 months and the incidence of sexually transmitted disease in the past 12 months.  WE found that over a quarter of participants were current smokers, 17% drank >21 units of alcohol per week, around a third had used recreational drugs in the past 6 months, and three-quarters reported a sexually transmitted infection in the past year.  Only 12.6% of participants reported none of these behaviours, with 17.6% reporting three or four of the risk behaviours.   Although there was a decline in the prevalence of this ‘high-risk’ phenotype as people aged, it was seen in all age groups.  There was some suggestions of an association between the high-risk phenotype and a history of mental health conditions, although this was not statistically significant.  However, there was strong evidence of an association with symptoms of depression as assessed by the PHQ-9 and CES-D equations (equations that have been validated to give a reliable indication of people with signs of depression).  People who exhibited this high risk phenotype were also more likely to reported <90% adherence to their ART, although this did not translate into an association with either the current viral load or the person’s CD4 count.

Next steps

Analyses are continuing to investigate other associations with this high-risk phenotype, and to describe the prevalence of the phenotype in HIV-negative POPPY participants.


These findings were presented as a poster at the BHIVA meeting in April 2017 [link to BHIVA poster].

Study group

Erica Pool (UCL), Manolis Bagkeris (UCL), Caroline Sabin (UCL), Alan Winston (Imperial College London), Paddy Mallon (University College Dublin).   Contact Caroline Sabin (