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Combined Alcohol Alcohol Treatment for people treating HIV improves both HIV and alcohol outcomes



Microscopic image of T cell infected with HIV. Credit: NIAID

A new clinical study supported by the National Institutes of Health shows that increasing the intensity of alcohol abuse treatment over time improves alcohol-related outcomes in people with HIV. This advanced approach to AUD also improves the means associated with HIV in the patient population. A report of the new study, led by researchers at Yale University, is now online The Lancet HIV.

"These research findings demonstrate the potential of combined therapy for AUD and HIV to improve health outcomes," said George W. Bush, Cobb, Ph.D., director of NIH's National Institute on Alcohol and Alcohol Abuse (NIAAA), provided initial funding for the new study, with additional funding provided by the National Institute on Drug Abuse (NIDA). "Furthermore, this highlights the importance of integrating treatment of alcohol issues into mainstream health."

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

"Many people with HIV are not aware of or are not looking for treatment for alcohol," says first author Jennifer Edelman, MD, a professor of medicine at Yale Medical School. In addition, clinical clinicians often do not understand that there are effective drugs and counseling that they can easily integrate into their practice for patients with alcohol abuse problems.

The authors note that previous studies have found that the combination of opioid use in HIV clinics improves both HIV and substance-related outcomes, and researchers have sought to assess whether such a model would benefit people with HIV and AUD.

Treatment for AUD rarely occurs in patients with HIV clinical treatment. This study combines the treatment of AUD with HIV treatment.

Dr. Adelman and her colleagues conducted a randomized clinical trial in five HIV clinics with 128 patients with HIV and AUD, who studied the combined treatment of alcohol (ISAT), an approach that included sequential increases in the intensity of AUD treatment if lower intensity therapy did not yield Desired results.

People in the ISAT group began treatment with the AUD with an addiction therapist on site, focusing on the use of drugs for AUD. If this stage did not stop heavy drinking, the next step involved adding behavioral intervention on the site to increase motivation to change drinking behavior and teach coping skills to manage 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 in one day or more during the last 14 days. Patients who continued to engage in heavy drinking were transferred to the final stage of referral for treatment of special addiction – such as inpatient intensive care or residential treatment depending on locally available resources. Patients in the control group were treated normally – including alcohol filtration, short intervention, and referral to VA special treatment at the discretion of their HIV clinic.

At the end of the six-month study, when both groups reported reduced alcohol intake, the researchers found no difference in weekly drinks or HIV outcomes between ISAT and control group. Both groups continued to treat AUD under normal care. In the next 12 months, people who initially received ISAT were found to be better than people who received treatment as usual. People in the ISAT group, for example, reported fewer drinks per day than people in the control group and a higher percentage of abstinence days. The ISAT group also had a higher rate of people who did not report heavy drinking days.

"Participants who were randomized to treat AUD were at a higher risk of getting undetectable HIV load," Dr. Adelman said. The researchers believe that with a decrease in alcohol consumption, participants in the ISAT group were more likely to take their HIV drugs consistently for translation to improved HIV control.

In a welcome commentary on a new study at The Lancet HIV, Colleagues Lorenzo Lajnu, MD, Ph.D., senior researcher in the NIH NIA Research Program of NIAA and NIDA, and Roberta Agbio, MD, psychiatrist at the University of Cagliari in Italy welcomed the new findings as important for the HIV field and beyond.

"Sophisticated treatment approaches have been found to be effective in treating a variety of chronic diseases," said Dr. Legg.

"These findings are a first indication of their potential value for treating HIV in the context of HIV treatment, and the results warrant further investigation into how to optimize its use among people with HIV and investigate its integration into other medical care settings, Of doctors trained in all areas of medicine to identify and treat AUD as a medical disorder accessible to a variety of therapeutic approaches. "

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more information:
Roberta Agbio et al. HIV and alcohol abuse: We can not ignore the elephant in the room, The Lancet HIV (2019). (19) 30074-8)

Edelman E, et al (2019). Combined Alcohol Alcohol Treatment for Patients with HIV and Alcohol Abuse: A Randomized Controlled Trial. The Lancet HIV. (198) 30076-1

Provided by
National Institutes of Health

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Integrated Alcohol Alcohol Treatment for People Treating HIV Improves both HIV and Alcohol Outcomes (2019, May 18)
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