Staged Integrated Alcohol Treatment for HIV-positive People Improves HIV and Alcohol Outcomes

New clinical research supported by the National Institutes of Health shows that the gradual increase in the intensity of treatment of alcohol consumption disorder (AUD) improves alcohol-related outcomes in people living with HIV. This gradual approach to AUD treatment also improves measures of HIV-related illness in this patient population. A report from the new study, led by researchers from Yale University, is now online in The HIV Lancet.

"These research findings demonstrate the potential of integrated treatment against AUD and HIV to improve health outcomes," said George F. Koob, Ph.D., director of the National Institute. Alcohol and Alcoholism (NIAAA) NIH, which provided the main funding for the new research, with additional funding provided by the National Institute on Drug Abuse (NIDA). "In addition, this highlights the importance of integrating the treatment of alcohol problems into conventional health care."

In the United States, estimates of the prevalence of people living with HIV who drink heavily or who have AUD range from 8% to 42%. Alcohol abuse can increase risk behaviors that increase the likelihood of contracting HIV or passing it on to others. Alcohol abuse can also accelerate the progression of HIV in people with HIV and make it more difficult to monitor drug treatment.

"Many HIV-positive people are unaware of or are not seeking treatment for their alcohol problems," said the first author, E. Jennifer Edelman, MD, M.H.S., associate professor of medicine at the Yale School of Medicine. "In addition, HIV clinicians often do not realize that there are medications and effective counseling that they can easily incorporate into their practice for patients with alcohol consumption problems. "

Noting that previous studies had shown that integrating treatment of opioid use disorder into HIV treatment clinics improved HIV and substance-related outcomes, researchers wanted to assess whether such a model would also benefit people living with HIV and AUD.

The treatment of AUD is often set apart by HIV clinical care. The present study integrates the treatment of AUD with HIV treatment.

Dr. Edelman and her colleagues conducted a randomized clinical trial in five HIV treatment clinics based on the Department of Veterans Affairs, involving 128 people with HIV and AUD. The researchers studied the Integrated Treatment of Stochastic Alcoholism (ISAT), an approach comprising several consecutive steps of increasing the intensity of AUD treatment if lower intensity treatment did not produce not the desired results.

The ISAT group members began their AUD treatment with an on-site addiction psychiatrist, focusing on the use of drugs for AUD. If this step did not stop alcohol abuse, the next step was to add an on-site behavioral intervention to increase motivation to change alcohol behavior and to teach coping skills. management of high-risk situations. Researchers have defined excessive drinking of five or more drinks a day for men and four or more drinks a day for women, one or more days in the last 14 days. Patients who continued to consume a lot of alcohol had reached the final stage of referral to specialized addiction treatment, such as intensive outpatient treatment or institution-based treatment. resources available locally. Patients in the control group received the usual treatment, which included alcohol screening, brief intervention, and referral to specialized addiction treatment in VA, at the discretion of their HIV clinician. .

At the end of the six-month study, while both groups reported a reduction in alcohol consumption, the researchers found no difference in weekly beverage consumption or HIV scores between ISAT groups and witnesses. Both groups then continued treatment with AUD under standard treatment (control conditions). At the 12-month follow-up, it was found that people who had initially received ISAT had better results than those who had only received the usual treatment. ISAT members, for example, reported drinking fewer drinks per day than control group members and a higher percentage of days of abstinence. The ISAT group also had a higher percentage of people who reported not drinking a lot of days.

"Importantly, we also observed that randomized participants to increase AUD treatment were more likely to achieve an undetectable HIV viral load," Dr. Edelman said. "We believe that with reduced alcohol consumption, participants in the ISAT group were more likely to take their HIV meds consistently, which resulted in improved viral control of HIV."

In a guest commentary on the new research in The HIV Lancet, co-authors Lorenzo Leggio, MD, Ph.D., principal investigator of the NIH intramural research program at NIAAA and NIDA, and Roberta Agabio, MD, psychiatrist at the University of Cagliari in Italy, hosted the news found to be important for the HIV Domain and beyond.

"Step-by-step approaches have proven effective in treating a variety of chronic conditions," said Dr. Leggio.

"These results are a first indication of their potential value for treating AUD in the context of HIV treatment, and the results need to be further explored to optimize the use of HIV in people with HIV and AIDS." To explore its integration into other settings of medical care, the study is a compelling example of the need for skilled clinicians spanning the entire spectrum of health care to recognize and treat the AUD as a disorder. medical amenable to a variety of treatment approaches. "