Medications for Alcohol Use Disorder Remain Underutilized, Especially Among People Living With HIV

Medications for alcohol use disorder (MAUD) are highly effective, yet they remain underutilized, particularly among people living with HIV (PLWH). Using 17 years of data from the US Veterans Aging Cohort Study, researchers examined predictors of MAUD initiation and retention among people with and without HIV who have alcohol use disorder (AUD). Initiation was defined as receipt of naltrexone (oral and injectable), acamprosate, or disulfiram within 30 days of diagnosis of AUD.* Retention was defined as filling the medication >80% of the days over six months.

• In the cohort of 163,339 individuals, 20% of PLWH had at least one AUD diagnosis compared with 22% of people without HIV.
• Out of the total population of people with AUD (n=35,027), 359 (1%) initiated MAUD and 49 (0.14%) were retained in treatment.
• The prevalence of MAUD initiation was lower among PLWH than among people without HIV (adjusted odds ratio, 0.66).
• Naltrexone was the most commonly prescribed MAUD, but its initiation was more common in people without HIV, compared with PLWH.
• Overall, older age and black race were associated with decreased odds of initiation of MAUD.

* Adding topiramate as an MAUD did not substantially change the results.

Comments: Despite MAUD being available for almost 70 years, people with AUD have minimal access to these highly effective medications; among the few who do access them, retention is extremely low. This study shows that other factors such as race and age may contribute to this gap, regardless of HIV status. Unlike most medications for opioid use disorder, MAUD are not controlled substances and do not require special licensure. Education for all healthcare professionals is overdue to increase access.

Melissa Weimer, DO, MCR

Reference: Oldfield B, McGinnis K, Edelman EJ, et al. Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV. J Subst Abuse Treat. 2020;109:14–22.