Alcohol-Addiction Drug Seems to Help Retroviral Compliance and Suppress HIV Levels

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Researchers at Yale University recently published research in the Journal of Acquired Immune Deficiency Syndrome (JAIDS) that found patients receiving a drug for alcohol addiction aided in retroviral treatment compliance and seemed to help suppress HIV levels.

The researchers, led by Sandra Springer, associate professor of Medicine (AIDS) and associate clinical professor of nursing, and director of Infectious Disease Outpatient Clinic at Yale Medicine, conducted a placebo-controlled, randomized clinical trial in individuals in prison in Connecticut. The study evaluated 100 individuals who had both HIV and alcohol use disorders (AUD) who were transitioning out of prison from 2010 through 2016.

The 100 eligible participants were randomized two to one to receive six monthly injections of XR-NTX (extended-release naltrexone), an FDA-approved drug for alcohol addiction, or a placebo. Their treatment began about a week before they were released. They were followed for six months after their release.

The researchers found that the participants receiving naltrexone were more likely to either have maintained or improved on suppression of their HIV. Viral suppression (VS) was considered to be plasma HIV RNA under 50 copies/mL.

Springer presented results from the study and another study of naltrexone in HIV patients with opioid use disorders at the Conference on Retroviruses and Opportunistic Infections (CROI) in March. Both studies were funded by the National Institutes of Health (NIH).

“In populations living with HIV, [even] just in the general community, substance use at any level interferes with the ability to stay adherent to medications and go to follow-up appointments,” Springer said in the talk, Healio: Infectious Disease News reported. “If you can help them stay sober, they are more likely to take their [ART} and keep their viral loads suppressed. So, a double edge. You can get two for one.”

Helio writes, “Among 100 participants in the INSPIRE trial, the proportion of patients in the intervention group who were virally suppressed increased from 31 percent at baseline to 56.7 percent at six months, whereas the proportion of virally suppressed patients in the placebo arm decreased from 42 percent to 30.3 percent. In the trial, receiving extended-release naltrexone was independently predictive of viral suppression, with an adjusted OR of 4.54 (95 percent CI, 1.43 to 14.43), Springer and colleagues reported. The adjusted OR of receiving three or more doses was 6.34 (95 percent CI, 2.08-19.29).”

The studies appear to have less to do with use of naltrexone in treating HIV/AIDS than its positive effects on getting recently released inmates to maintain their treatment regimens. Low dose naltrexone has been used to treat HIV/AIDS patients since the mid-1980s.

In 2001, researchers with the Institute for Brain and Immune Disorders, Minneapolis Medical Research Foundation, Hennepin County Medical Center and the University of Minnesota Medical School, published research in Drug and Alcohol Dependence titled, “Naltrexone potentiates anti-HIV-1 activity of antiretroviral drugs in CD4+ lymphocyte cultures.”

The authors stated that, “We sought to determine whether the non-selective opioid receptor antagonist naltrexone would affect HIV-1 expression in CD4(+) lymphocyte cultures and whether naltrexone would alter the antiviral properties of zidovudine (AZT) or indinavir.”

The tests were laboratory-based, and found that, “While naltrexone alone did not affect HIV-1 expression, at a concentration of 10(-12)-10(-10) M naltrexone increased the antiviral activity of AZT and indinavir 2-3-fold. Similar findings with a kappa-opioid receptor (KOR) selective antagonist supported the possible involvement of KOR in naltrexone’s potentiation of the antiretroviral drugs. The results of this in vitro study suggest that treatment of alcohol or opiate dependent HIV-1-infected patients with naltrexone is unlikely to interfere with the activity of antiretroviral drugs.”

Numerous studies have followed.

In her talk at CROI, Springer said, “We know without a doubt, it doesn’t matter how long you’ve been incarcerated, how long you’ve gone for forced abstinence, relapse occurs quickly.” And referring specifically to people living with HIV, she said, “If you can help them stay sober, they are more likely to take their antiretroviral therapy and keep their viral load suppressed.”

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