Studies have found that opioid agonist therapy with methadone and buprenorphine/naloxone for the treatment of OUD improves HIV outcomes. Though pharmacotherapy for AUD is uncommon in HIV clinics, it is also associated with decreased HIV RNA levels.
The CTN-0055 protocol, Comparing Treatments for HIV-Positive Opioid Users in an Integrated Care Effectiveness Study (CHOICES), aimed to inform development of a multi-site comparativeness effectiveness trial of extended-release naltrexone (XR-NTX) versus treatment as usual (TAU) in HIV clinics for improving engagement in HIV care. The non-blinded, randomized study compared XR-NTX treatment initiation, retention, and safety of XR-NTX versus treatment as usual for treating OUD and/or AUD in HIV clinics. The study was set in HIV primary care clinics in Vancouver, British Columbia, and Chicago, Illinois. Fifty-one HIV-infected patients seeking treatment for OUD (n=16), AUD (n=27), or both (n=8) were randomized. Primary outcomes were XR-NTX initiation (receipt of first injection within 4 weeks of randomization) and retention at 16 weeks. Secondary outcomes generated point estimates for change in substance use, HIV viral suppression, and safety.
Treatment initiation and retention:
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Safety: XR-NTX was well-tolerated, with no precipitated withdrawals and only 1 serious injection site reaction.
Conclusions: Extended-release naltrexone (XR-NTX) is feasible and safe for treatment of opioid use disorder and alcohol use disorder in HIV clinics. Treatment initiation appears to be lower and retention greater for XR-NTX compared with treatment as usual. The findings underscore the need for a multi-site trial (now also being performed by the CTN, see CTN-0067 for more information) to test the potential of XR-NTX for improving engagement in the HIV care continuum. Use of long-acting addiction pharmacotherapies such as XR-NTX may improve the capacity for HIV-infected patients with substance use disorders to better engage in HIV treatment and close gaps in the HIV care continuum.
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Korthuis PT, et al. Feasibility and Safety of Extended-Release Naltrexone Treatment of Opioid and Alcohol Use Disorder in HIV Clinics: A Pilot/Feasibility Randomized Trial. Addiction 2017 (in press)