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Integrated step-by-step alcohol treatment for people in HIV care improves both HIV and alcohol outcomes

Microscopic image of an HIV-infected T cell. Picture credits: NIAID

New clinical trials, supported by the National Institutes of Health, show that the increasing intensity of the treatment of alcohol consumption disorders (AUD) over time improves the alcohol-related outcomes in people living with HIV. This gradual approach to AUD treatment also improves responses to HIV-related diseases in this patient population. A report on the new study, which was led by researchers from Yale University, is now online in The Lancet HIV .

"These findings demonstrate the potential for integrated treatment of AUD and HIV to improve health outcomes," said Dr. George F. Koob, director of the NIH's National Alcohol Abuse and Alcoholism Institute (NIAAA), provided the primary funding for the new research, with additional funding from the National Institute for Drug Abuse (NIDA). "In addition, it underlines the importance of integrating the treatment of alcohol problems into general health care."

In the United States, estimates of the prevalence of HIV-infected individuals who either drink heavily or AUD fluctuate between 8% and 8% 42%. Alcohol abuse can lead to risky behaviors that increase the likelihood of becoming infected with or transmitting HIV to others. Alcohol abuse can also speed up the progression of HIV in people with HIV infection and make it difficult to follow drug regimens.

"Many people with HIV are unaware of their alcohol problems or seek treatment," said lead author E. Jennifer Edelman, MD, MHS, associate professor of medicine at the Yale School of Medicine. "In addition, HIV clinicians often fail to realize that there are effective medications and counseling that can easily integrate them into their practice for patients with alcohol problems."

Previous studies have found that the treatment of opioid use disorders can be integrated In HIV clinics, both HIV and substance-related outcomes are improving, and researchers wanted to evaluate whether such a model would be more appropriate for people with HIV and AUD Way.

AUD treatment is often independent of clinical care for a person. The current study integrates the treatment of AUD with the treatment of HIV.

Dr. Edelman and her colleagues conducted a randomized clinical trial in five Veterans Affairs-based HIV clinics with 1

28 people with HIV infection and AUD. The researchers looked at Integrated Stepwise Alcohol Treatment (ISAT) – an approach that involved successive steps of increased AUD treatment intensity when lower intensity treatment did not produce the desired results.

The patients of the ISAT group started their AUD treatment with a local addiction psychiatrist focusing on the use of drugs for AUD. If this step did not stop drinking a lot, the next step was to add an on-the-spot behavioral practice to increase the motivation to change the drinking behavior and to provide coping skills for dealing with high-risk situations. The researchers defined heavy drinking as five or more drinks a day for men and four or more drinks a day for women on one or more days in the previous 14 days. Patients who continued to drink heavily were transferred to a special treatment for addiction during the last step of the referral – such as intensive out-patient care or inpatient care, depending on the resources available on-site. Patients in the control group received the usual treatment, including alcohol screening, brief intervention, and referral for special treatment to the VA at the discretion of their HIV practitioner.

At the end of the six-month study, while both groups reported a decreased alcohol intake, the researchers found no differences in the drinks per week or the HIV outcomes between the ISAT and the control group. Both groups then continued AUD treatment under normal (control) conditions. At the 12-month follow-up, it was found that people who had originally received ISAT were better off than those who were treated as usual. For example, the ISAT group claimed to consume fewer drinks per drinking day than the control group and to have a higher percentage of abstinence days. The ISAT group also had a higher percentage of people who reported no days of heavy drinking.

"It is also important that randomly selected participants with graded AUD treatment are more likely to achieve undetectable levels of HIV viral load," Dr. Edelman. "We believe ISAT participants are more likely to consume their HIV medication more consistently with reduced alcohol consumption, resulting in improved HIV viral control."

In an invited commentary on the new research results of The Lancet HIV coauthors med. Lorenzo Leggio, Senior Investigator of the NIH Intramural Research Program at NIAAA and NIDA; med. Roberta Agabio, psychiatrist at the University of Cagliari in Italy, said the new findings are important for HIV and beyond.

"Stepwise treatment approaches have proven effective in the treatment of a variety of chronic diseases," said Drs. Leggio.

"These results are a first indication of their potential value." The findings justify further research into optimizing HIV use and studying its integration with other medical facilities. "The study is indeed a compelling example of the need that trained physicians throughout the healthcare sector recognize and treat AUD as a medical disorder suitable for a variety of treatment approaches. "

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Further information:
Roberta Agabio et al. HIV and Alcohol Consumption Disorder: We Can not Ignore the Elephant in the Room The Lancet HIV (2019). dx.doi.org/10.1016/S2352-3018(19)30074-8

Edelman E. et al. (2019). Integrated Gradual Alcohol Treatment for Patients with HIV and Alcohol Use Disorder: A Randomized Controlled Trial. The Lancet HIV . dx.doi.org/10.1016/S2352-018(19)30076-1

Provided by
National Health Institute

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Integrated Graded Alcohol Treatment for People in HIV Care Improves Both HIV and Alcohol Outcomes (2019, May 18)
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