Ageing, menopause and HIV treatment: Linking patient priorities to clinical and quality of life outcomes across antiretroviral treatment regimens
Supervisors: Dr Kate Alford Dr Fiona Cresswell Prof Jaime Vera
Application deadline: Friday 30 January 2026
Funded PhD Project (UK Students Only)
About the Project
Applications are invited for a 3-year funded PhD studentship at Brighton and Sussex Medical School to explore HIV treatment preferences in older and peri/post-menopausal people living with HIV. People with HIV are living longer, and those accessing HIV care are ageing: in 2023, 51% of those in care were aged 50 or older, up from 27% in 2013. As individuals living with HIV age, the balance of benefits and risks across antiretroviral therapy (ART) regimens changes. Older adults and peri/post-menopausal women commonly experience multimorbidity, polypharmacy, bone and cardiometabolic risk, vasomotor and sleep disturbance, mood symptoms, and cognitive complaints, all of which can interact with ART choices. Even when virological efficacy is equivalent, differences in neuropsychiatric effects, weight gain, renal and bone safety, drug–drug interactions (including with hormone replacement therapy and medicines for ageing-related conditions), along with the practical demands of dosing or clinic visits, can meaningfully affect quality of life and treatment adherence.
Despite this, the evidence guiding regimen choice in these groups is limited. Pivotal trials that influence treatment guidelines often under-represent women, older people and exclude those with complex comorbidities. Moreover, trials rarely prioritise patient-reported outcomes such as sleep, mood, treatment satisfaction, day-to-day functioning and broader quality of life. Real-world data are fragmented and do not offer clear comparative guidance across contemporary options (e.g. different integrase inhibitor-based combinations, nucleoside reverse transcriptase inhibitor backbones and novel long-acting injectable therapy). Clinicians therefore often extrapolate data arising from younger, healthier people, risking suboptimal choices for those most affected by age- and menopause-related needs.
There is a need for clear, patient-centred evidence to determine which ART regimens optimise virological suppression, cardiovascular health, metabolic and musculoskeletal outcomes, general tolerability, and quality of life for older and peri/post-menopausal adults. A programme that integrates clinical outcomes with patient-reported measures, captures multimorbidity and polypharmacy, and considers acceptability and service delivery will influence national treatment policy and support individualised, menopause and age-responsive HIV care.
This PhD will sit within the PEARL Study, a UK research study working with several NHS hospitals to understand which HIV treatments work best for older adults and individuals around or after the menopause. Using PEARL’s data and clinic links, this PhD studentship will explore three sequential areas: first, a review of existing research to summarise which ARTs are most durable and well tolerated, and how they affect everyday life, sleep, mood, weight, bone and kidney health, overall quality of life, and treatment satisfaction. Second, interviews with older adults and peri/post-menopausal people living with HIV will identify what matters most when choosing and living with treatment, and the trade-offs people are willing to make. Third, analyses of PEARL’s real-world datasets, from people using commonly prescribed tablet regimens and those who have recently switched treatments, to assess how well different regimens deliver on those priorities to help guide future HIV care. The project includes strong patient and public involvement, national collaboration across NHS trusts, and opportunities to share findings widely so services can be tailored to what matters most to people living with HIV.
Research Environment
The student will join the HIV, Sexual Health and Women’s Health Research Group within the Department of Global Health and Infection. The group are global leaders in Ageing and HIV research, with experts in clinical HIV medicine, epidemiology, qualitative methods, psychology, health services research and patient public involvement. The group runs regular seminars and the annual UK Ageing & HIV conference. Additionally, they work closely with national and local HIV charities to support co-production, recruitment and impact. Embedded NHS partnerships include University Hospitals Sussex and a wider UK network, providing access to real-world clinics, experienced clinical research teams, robust R&D governance/data-sharing, and secure data infrastructure for mixed-methods studies.
Entry requirements
This studentship is suitable for those with background in a health-related field (e.g., public health/epidemiology, psychology, biomedical sciences, social sciences or another relevant subject area). We invite applications from students who have received or are on target to achieve a relevant undergraduate degree with minimum 2:1 classification (or equivalent). An MSc and previous research experience are desirable but not essential. Strong interpersonal skills and a collaborative attitude are essential.
How to apply
Applicants must apply through the University’s application Portal (StudentView) where they can submit a CV and complete the application form. The deadline for applications is 30th January 2026. Interviews will be held in February 2026. Informal enquiries are very much welcomed and should be submitted to Dr Kate Alford – K.Alford3@bsms.ac.uk
Funding Notes
This is a 3-year PhD studentship funded by Brighton and Sussex Medical funded, starting on 1 October 2025. Funding will cover tuition fees for UK students (at the Home rate), a stipend at the UKRI rate and a research allowance which will cover research running costs. International applicants are welcome to apply but will be required to cover the difference between Home and International fees.
References
- Hosein S. Biktarvy found safe and effective in people aged 65 and older. CATIE cohort. 2023.
- Lazzaro A, Cacciola EG, Borrazzo C, Innocenti GP, Cavallari EN, Mezzaroma I, et al. Switching to a bictegravir single tablet regimen in elderly people living with HIV-1: data analysis from the BICTEL cohort. Diagnostics. 2021;12(1):76.
- Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, Sighem A, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis. 2015;15(7):810-8.
- Okhai H, Sabin C, Haag K, Sherr L, Dhairyawan R, Shephard J, et al. The prevalence and patterns of menopausal symptoms in women living with HIV. AIDS and Behavior. 2022;26(11):3679-88
- Lee S, Oh JW, Park KM, Ahn JY, Lee S, Lee E. The prevalence and moderating factors of sleep disturbances in people living with HIV: a systematic review and meta-analysis. Scientific Reports. 2024;14(1):14817.
- Tariq S, Burns, F., Rolland, A., Sabin, C., Sherr, L., Gilson, R. Menopausal symptoms are associated with psychological distress in HIV+ women. 8th Internation Workshop on HIV & Women; Boston, USA2018.
- Ahmed GY, Saha C, Almusalami EM, Rabaan AA, Alhumaid S, Ali AA, et al. Prevalence of Depression in Elderly People Living With HIV: A Systematic Review and Meta-analysis. Infectious Microbes & Diseases. 2023;5(4):167-71.