Women living with HIV are less likely than men to achieve viral suppression with antiretroviral therapy. Reduction in alcohol use is a possible strategy to improve health outcomes in women with HIV, with evidence that unhealthy alcohol use (>7 drinks per week or >4 drinks per occasion for women) is associated with poorer adherence to treatment, lower rates of viral suppression, and faster disease progression.
Several medications are available on prescription to help reduce drinking, including naltrexone, which is taken as a once-daily pill; however, none have been studied in relation to clinical outcomes in people with HIV. Researchers from universities in Florida have conducted a clinical trial, published in the journal Alcoholism: Clinical & Experimental Research, to understand the effect of naltrexone on drinking behavior and clinical outcomes in women with HIV who engage in unhealthy alcohol use, exceeding recommended drinking levels.
Almost 200 women with HIV who reported having more than seven drinks per week, or more than three drinks per occasion, were randomly assigned to take either daily naltrexone or a placebo pill for 4 months. The participants, most of whom were African American and receiving HIV antiretroviral therapy, were followed up for a total of 7 months and encouraged to adhere to their allocated treatment for four months.
At the start of the trial all the women met criteria for unhealthy alcohol use, 62% met criteria for an alcohol use disorder, and only 63% had HIV viral suppression. Women in both groups substantially reduced their drinking over the course of the study; only around half of participants reported ongoing unhealthy alcohol use at four months, and this proportion continued to drop even after stopping the medication. Although women taking naltrexone initally showed a greater reduction in drinking than those assigned to placebo, there was no difference between the two groups from four months onwards; at seven months, 64% of women in each group had reduced or quit drinking.
Laboratory analysis showed that HIV viral suppression was significantly more common among women who had reduced or quit drinking than in those who continued to drink at unhealthy levels; after 7 months, 74% of those who had reduced or quit drinking had HIV viral suppression, compared with 54% of those who had not cut their alcohol intake.
While naltrexone has been shown to be effective in prior studies, the current decrease in drinking regardless of medication assignment suggests that repeated assessments and support that participants receive in a research study could serve to augment treatment success. Alcohol reduction was associated with improved HIV viral suppression, supporting recommendations for women living with HIV to avoid unhealthy alcohol use.
Cook, R.L. et al. (2019) Reduction in Drinking was Associated With Improved Clinical Outcomes in Women With HIV Infection and Unhealthy Alcohol Use: Results From a Randomized Clinical Trial of Oral Naltrexone Versus Placebo. Alcoholism: Clinical and Experimental Research. doi.org/10.1111/acer.14130.