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Addiction. 2017 Jun;112(6):1036-1044. doi: 10.1111/add.13753. Epub 2017 Feb 8.

Feasibility and safety of extended-release naltrexone treatment of opioid and alcohol use disorder in HIV clinics: a pilot/feasibility randomized trial.

Author information

1
Oregon Health and Science University, Portland, OR, USA.
2
University of California, San Francisco, CA, USA.
3
Ruth M. Rothstein CORE Center, Chicago, IL, USA.
4
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
5
University of British Columbia, Vancouver, BC, Canada.
6
EMMES Corporation, Rockville, MD, USA.
7
National Institutes of Health, National Institute on Drug Abuse, Bethesda, MD, USA.

Abstract

BACKGROUND AND AIMS:

HIV-infected people with substance use disorders are least likely to benefit from advances in HIV treatment. Integration of extended-release naltrexone (XR-NTX) into HIV clinics may increase engagement in the HIV care continuum by decreasing substance use. We aimed to compare (1) XR-NTX treatment initiation, (2) retention and (3) safety of XR-NTX versus treatment as usual (TAU) for treating opioid use disorder (OUD) and/or alcohol use disorder (AUD) in HIV clinics.

DESIGN:

Non-blinded randomized trial of XR-NTX versus pharmacotherapy TAU.

SETTING:

HIV primary care clinics in Vancouver, BC, Canada and Chicago, IL, USA.

PARTICIPANTS:

Fifty-one HIV-infected patients seeking treatment for OUD (n = 16), AUD (n = 27) or both OUD and AUD (n = 8).

MEASUREMENTS:

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 [HIV RNA polymerase chain reaction (pcr) < 200 copies/ml] and safety.

FINDINGS:

Two-thirds (68%) of participants assigned to XR-NTX initiated treatment, and 88% of these were retained on XR-NTX at 16 weeks. In comparison, 96% of TAU participants initiated treatment, but only 50% were retained on medication at 16 weeks. Mean days of opioid use in past 30 days decreased from 17.3 to 4.1 for TAU and from 20.3 to 7.7 for XR-NTX. Mean heavy drinking days decreased from 15.6 to 5.7 for TAU and 12.5 to 2.8 for XR-NTX. Among those with OUD, HIV suppression improved from 67 to 80% for XR-NTX and 58 to 75% for TAU. XR-NTX was well tolerated, with no precipitated withdrawals and one 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 (clinicaltrials.gov NCT01908062).

KEYWORDS:

Alcohol; HIV; extended-release naltrexone; injection drug use; opioid-related disorders; randomized clinical trial

PMID:
28061017
PMCID:
PMC5408318
DOI:
10.1111/add.13753
[Indexed for MEDLINE]
Free PMC Article

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