In a randomized controlled study in which people with HIV and alcohol use disorder (AUD) were put through progressively intensifying treatment for AUD if each successive step was not successful, this program was associated with reduced alcohol intake and a higher rate of viral suppression compared with the standard of care.
Publishing their findings in The Lancet, researchers conducted a multisite randomized controlled trial in five Veterans Affairs (VA)–based HIV clinics—in Atlanta, Brooklyn and Manhattan, Dallas and Houston, and Washington, DC. The study evenly randomized 128 people with HIV and AUD to either the so-called integrated stepped alcohol treatment (ISAT) or the standard of care for people with both the virus and the alcohol condition.
The members of the ISAT group began treatment for AUD with an addiction psychiatrist who was on-site at their VA clinic. This clinician focused on treating AUD with medication. If this intervention did not lead the participants to stop heavy drinking—defined as five or more drinks per day for men and at least four daily drinks for women on at least one day during the previous 14 days—then they were given a behavioral intervention on-site meant to motivate them to alter their drinking behavior and teach them coping skills for managing high-risk situations.
Those who were still drinking heavily after that treatment phase received the last step of ISAT: a referral to specialty addiction treatment, which could mean intensive outpatient treatment or residential treatment, depending on availability in the participant’s area.
The standard-of-care group received alcohol use screening, a brief intervention meant to encourage them to lessen their drinking and, if the HIV clinician so chose, a referral to specialty addiction treatment at the VA.
Twenty-four weeks into the study, the members of both groups had lessened their use of alcohol, although there were no differences between the study arms in the average number of drinks per week or the rate of full suppression of HIV.
After this point, both groups received the standard of care going forward.
Then, one year after entering the study, those who had been randomized to the ISAT group, compared with those in the control group, did indeed report having fewer drinks on each day that they drank and also reported more days when they did not drink. Additionally, a greater proportion of the ISAT group’s members reported no days during which they drank heavily.
By this point, a greater percentage of the ISAT group compared with the control group had a fully suppressed viral load.
The study authors believe that the intensified AUD treatment led participants to adhere better to their antiretroviral treatment.
To read a press release about the study, click here.
To read the study abstract, click here.
To access the abstract of the accompanying editorial in The Lancet, click here.