In a 2022 study, investigators aimed to report associations between people living with HIV and the growing evidence suggesting that those with HIV have considerable morbidity from alcohol, cigarette smoking, and recreational drug use. People living with HIV were recruited from 8 outpatient clinics in England from February 2011 to December 2012. The data were self-reported excessive drinking, alcohol dependency, recreational drug use, and smoking status. Of the 3,258 patients who were recruited, 69.0% were men who have sex with men, 11.4% were heterosexual men, and 19.6% were women.

A CAGE score of at least 2 was found in 17.6% of the participants, 10.1% of participants drank over 20 units per week of alcohol, 31.5% currently smoked, 38.1% used recreational drugs, and 2.3% had reported injection drug use. Of the 2,459 participants who started antiretroviral therapy at least 6 months prior, a CAGE score of at least 2, drinking over 20 units per week, current smoking status, injection, and non-injection drug use were all associated with antiretroviral non-adherence. It was concluded that screening and treatment for alcohol, cigarette, and drug use should be implemented into the HIV outpatient clinics, and clinicians should be aware of potential poorer virological outcomes in this population.