Home > ASME Articles > Extended-release Naltrexone for Treatment of Opioid and Alcohol Use Disorders in HIV Clinics
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.
Results included:
Treatment initiation and retention:
Substance use levels:
Viral suppression: Among those with OUD, HIV suppression improved from 67% to 80% for XR-NTX and 58% to 75% for TAU.
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.
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