‘Stepped’ treatment reduces drinking in patients with HIV

Alcohol abuse is common among people with HIV, leading to a host of medical and public health problems. Yet, alcohol use and addiction treatment is rarely administered in HIV clinics.

Now a Yale-led study has shown that undergoing an approach to care known as integrated stepped alcohol treatment helped HIV patients drink less.

The finding supports greater use of this treatment model in HIV clinics to improve outcomes for patients with both HIV and drinking problems, the researchers said.

The study was published in The Lancet HIV.

Stepped care is used to treat some patients with chronic diseases such as hypertension and depression. It entails the use of different treatments that are “stepped up,” or increased in intensity over time, in response to patients’ needs.

Prior to this new study, little research had been done to evaluate the impact of stepped care for patients struggling with alcohol use disorder, and none had been conducted in HIV treatment settings, the researchers said.

Alcohol use disorder is common among people with HIV, and this has implications for clinical outcomes, said Nathan Hansen, a health promotion and behavior professor at the University of Georgia College of Public Health and fellow study author.

Yet clinicians have been reluctant to address substance use and addiction with HIV patients.

Alcohol use has historically been viewed as moral failing rather than a medical condition, said Hansen, and as a result many clinicians won’t treat HIV patients until they’ve kicked their alcohol habit. But that approach ultimately hurts patients.

“If someone comes into the clinic and they have HIV, but they also have cancer, you would treat the cancer. Why would you treat an addiction like alcohol that also is going to have a negative health consequence differently? It just makes sense to treat the whole individual.”

The research team recruited 128 individuals from one of five Veterans Affairs-based HIV clinics. They randomized the patients into one of two groups — those given integrated stepped alcohol treatment and an equal number receiving treatment as usual.

At the end of the study period, the researchers found that patients who received integrated stepped care fared better overall.

“We saw overall improvements in drinking,” said Jennifer Edelman, M.D., lead author and associate professor in internal medicine. “We also found improved HIV outcomes at the 52-week mark.”

The improvements in patients’ HIV status were presumably associated with the reduced alcohol use, Edelman noted.

“Over time, the patients receiving integrated stepped care showed decreases in alcohol use and a higher rate of undetectable HIV viral load, likely related to improved HIV medication adherence,” she said.

The study results support the expanded use of integrated stepped care for alcohol misuse in settings where patients are already being treated for HIV, the researchers said.

David Fiellin, M.D., was the principal investigator. Other study authors are Stephen Maisto, Christopher Cutter, James Dziura, Yanhong Deng, Lynn Fiellin, Patrick O’Connor, Roger Bedimo, Cynthia Gibert, Vincent Marconi, David Rimland, Maria Rodriguez-Barradas, Michael Simberkoff, Janet Tate, Amy Justice, and Kendall Bryant.

This work was supported by grants from the National Institute on Alcohol Abuse and Alcoholism. Edelman was supported as a Yale-Drug Abuse, HIV and Addiction Research Scholar.

By Lauren Baggett

This story was adapted with permission from Yale News.

Posted on May 23, 2019.