‘Stepped’ treatment reduces drinking in patients with HIV

People with HIV who drink too much were more likely to reduce drinking after undergoing an approach to care known as integrated stepped alcohol treatment, according to a Yale-led study.

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.

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.

The stepped-care patients were offered evidence-based treatments, including medication, motivational therapy, and specialty care at either an outpatient or residential treatment facility. By comparison, the treatment-as-usual patients were referred to specialty addiction treatment at the VA at the discretion of their HIV clinician.

At the end of the study period, the researchers found that patients who received integrated stepped care fared better overall. After 52 weeks, stepped-care patients had fewer heavy drinking days, drank less per drinking day, and had more days of abstinence, the researchers noted.

“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.

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.

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