Affiliations 

  • 1 Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510-2283, United States; Yale University School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT 06510-2283, United States. Electronic address: Sandra.springer@yale.edu
  • 2 Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510-2283, United States
  • 3 Yale University School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT 06510-2283, United States
  • 4 State University of New York at Albany, Department of Communication, Albany, NY, United States
  • 5 Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510-2283, United States; Yale University School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT 06510-2283, United States; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, United States; Centre of Excellence in Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
Drug Alcohol Depend, 2017 05 01;174:158-170.
PMID: 28334661 DOI: 10.1016/j.drugalcdep.2017.01.026

Abstract

BACKGROUND: Alcohol use disorders (AUDs) are highly prevalent among persons living with HIV (PLH) within the criminal justice system (CJS). Extended-release naltrexone (XR-NTX) has not been previously evaluated among CJS-involved PLH with AUDs.

METHODS: A randomized, double-blind, placebo-controlled trial was conducted among 100 HIV+ prisoners with AUDs. Participants were randomized 2:1 to receive 6 monthly injections of XR-NTX or placebo starting one week prior to release. Using multiple imputation strategies for data missing completely at random, data were analyzed for the 6-month post-incarceration period. Main outcomes included: time to first heavy drinking day; number of standardized drinks/drinking day; percent of heavy drinking days; pre- to post-incarceration change in average drinks/day; total number of drinking days; and a composite alcohol improvement score comprised of all 5 parameters.

RESULTS: There was no statistically significant difference overall between treatment arms for time-to-heavy-drinking day. However, participants aged 20-29 years who received XR-NTX had a longer time to first heavy drinking day compared to the placebo group (24.1 vs. 9.5days; p<0.001). There were no statistically significant differences between groups for other individual drinking outcomes. A sub-analysis, however, found participants who received ≥4 XR-NTX were more likely (p<0.005) to have improved composite alcohol scores than the placebo group. Post-hoc power analysis revealed that despite the study being powered for HIV outcomes, sufficient power (0.94) was available to distinguish the observed differences.

CONCLUSIONS: Among CJS-involved PLH with AUDs transitioning to the community, XR-NTX lengthens the time to heavy drinking day for younger persons; reduces alcohol consumption when using a composite alcohol consumption score; and is not associated with any serious adverse events.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.