Alcohol use in people with HIV

People with HIV who drink too much were more likely to reduce drinking after undergoing; an approach to care known as integrated stepped alcohol treatment, according to a Yale-led study. The finding supports greater use of this treatment model in HIV clinics; but to improve outcomes for patients with both HIV and drinking problems, the researchers said. The study was published in The Lancet HIV.

Stepped care is using to treat some patients with chronic diseases such as hypertension and depression. It entails the use of different treatments that are stepping up; or increased in intensity over time, in response to patients’ needs. Prior to this new study, little research was doing to evaluate; but the impact of stepping care for patients struggling with alcohol use disorder, and none was conducting; in HIV treatment settings, the researchers said.

Evidence-based treatments

The research team recruited 128 individuals from one of five Veterans Affairs-based HIV clinics. They randomized the patients into one of two groups those given integrated stepped alcohol treatment; and an equal number receiving treatment as usual. The stepped-care patients were offering evidence-based treatments; including medication, motivational therapy, and specialty care at either an outpatient or residential treatment facility. By comparison, the treatment-as-usual patients were referring; to specialty addiction treatment at the VA at the discretion of their HIV clinician.

At the end of the study period, the researchers found that patients who received integrated stepped care fared better overall. After 52 weeks, stepped-care patients had fewer heavy drinking days, drank less per drinking day, and had more days of abstinence, the researchers noted. “We saw overall improvements in drinking. We also found improved HIV outcomes at the 52-week mark,” said Jennifer Edelman, M.D., Lead Author and Associate Professor in Internal Medicine.

HIV medication adherence

The improvements in patients’ HIV status were presumably associated with the reduced alcohol use, Edelman noted. “Over time, the patients receiving integrated stepped care showed decreases in alcohol use and a higher rate of undetectable HIV viral load, likely related to improved HIV medication adherence,” she said. The study results support the expanding use of integrating stepped care for alcohol misuse; but in settings where patients are already being treating for HIV, the researchers said.

ISAT increases the receipt of alcohol treatment medications and counselling without changes in drinking at week 24. Strategies to implement and enhance ISAT are needed. Future efforts should focus on promoting ISAT with attention to enhancing patient engagement and retention in alcohol-related care.