Many incarcerated people living with HIV (PLWH) achieve viral suppression in jail/prison, but post-release they may experience low linkage to HIV care, high rates of return to substance use, and unstable housing, all of which can undermine adherence to antiretroviral therapy (ART). This double-blind, placebo-controlled randomized trial examined the efficacy of XR-NTX in 100 incarcerated PLWH who also had alcohol use disorder. Outcomes were viral suppression to <200 copies/mL and <50 copies/mL 6 months after release.
- Overall, XR-NTX was associated with viral suppression at <200 copies/mL (48% versus 65%) and <50 copies/mL (31% versus 57%) at 6 months.
- Receipt of 3- and 6-month injections was 57% and 15% respectively for XR-NTX and 45% and 18% respectively for placebo.
- Receipt of ≥3 injections of XR-NTX was associated with viral suppression at <200 copies/mL and <50 copies/mL (adjusted odds ratio, 3.26 and 6.34 respectively).
- Reduced alcohol consumption and white race were additional factors associated with viral suppression at <50 copies/mL.
Comments: Though limited by a high attrition rate, this study confirms the important role of treating alcohol use disorder in improving HIV treatment outcomes. Future research should focus on the implementation and evaluation of strategies to improve alcohol use disorder treatment retention among HIV infected individuals in the period following release from a correctional facility.
Jeffrey Morgan† and Seonaid Nolan, MD
† Contributing editorial intern and Research Coordinator for the British Columbia Centre on Substance Use
Reference: Springer SA, Di Paola A, Barbour R, et al. Extended-release naltrexone improves viral suppression among incarcerated persons living with HIV and alcohol use disorders transitioning to the community: results from a double-blind, placebo-controlled trial. J Acquir Immune Defic Syndr. 2018;79(1):92–100.