Higher Intensity of Behavioral Treatment for Alcohol Use Disorder is Associated With Improved HIV-related Outcomes

Little is known about the effects of behavioral treatment and medication for alcohol use disorder (BAUD and MAUD, respectively) on health outcomes among people living with HIV. Researchers used data from the US Veterans Aging Cohort Study to describe BAUD intensity and MAUD utilization—and their association with HIV-related outcomes—among 7830 participants with a new AUD-related treatment encounter and ≥12 months of prior follow-up for comparison.

• The intensity of BAUD was categorized by treatment days/month over the 12 months following initiation: 35% of the cohort received a single visit; 44% received minimal BAUD (mean of 2 visits); 17% received sustained moderate BAUD (starting with a mean of 8 visits, gradually declining to 1–2 visits/month); and 4% received intensive BAUD (starting with a mean of 14–16 visits/month, gradually declining to 7 visits/month).
• 20% of the cohort received MAUD. Gabapentin was the most commonly prescribed (86%), followed by naltrexone (9%), topiramate (7%), acamprosate (2%), and disulfiram (1%).
• Among individuals with baseline detectable HIV viral load (VL), higher-intensity BAUD was associated with improved VL, CD4 cell count, medication adherence, and HIV disease severity, compared with those receiving lower-intensity BAUD.
  • For individuals with undetectable VL at baseline, only antiretroviral medication adherence was significantly improved among those receiving higher-intensity BAUD compared with those receiving lower-intensity BAUD.
• MAUD receipt was associated with improved antiretroviral medication adherence for individuals with detectable and undetectable VL, and improved CD4 counts among those with a detectable VL, compared with individuals who did not receive MAUD. Other outcomes were not significantly improved.

Comments: This study found that few patients with AUD and HIV receive BAUD beyond minimal intensity. It may be that higher-intensity BAUD could improve HIV outcomes, particularly for individuals with detectable viral loads. The role of MAUD is less clear, especially since only a small number of participants in this study received FDA-approved medications for AUD.

Darius A. Rastegar, MD

Reference: McGinnis KA, Skanderson M, Edelman EJ, et al. Impact of behavioral and medication treatment for alcohol use disorder on changes in HIV-related outcomes among patients with HIV: a longitudinal analysis. Drug Alcohol Depend. 2020;217:108272.