Will Having Alcohol Treatment Improve Functioning?
| Status: | Completed |
|---|---|
| Conditions: | HIV / AIDS, Psychiatric |
| Therapuetic Areas: | Immunology / Infectious Diseases, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/9/2018 |
| Start Date: | November 2010 |
| End Date: | October 2012 |
Pharmacotherapy for Hazardous Drinking in HIV Infected Women: Randomized Trial
The purpose of the study is to find out if a medication,naltrexone is helpful for
HIV-infected women who sometimes drink too much. The study will try to find out whether women
like the medication, whether the medication helps them cut back on their drinking, and
whether it helps improve their overall health. Naltrexone has not been used widely among
people who are engaged in less severe drinking and in primary health care settings.
Therefore, the investigators would like to determine whether it is helpful among women who
sometimes drink 4 or more drinks per occasion or 7 or more drinks per week. The investigators
hypothesize that by taking naltrexone, women with hazardous drinking pattern will reduce
their drinking which in turn will improve their medication adherence, improve their health
and quality of life.
HIV-infected women who sometimes drink too much. The study will try to find out whether women
like the medication, whether the medication helps them cut back on their drinking, and
whether it helps improve their overall health. Naltrexone has not been used widely among
people who are engaged in less severe drinking and in primary health care settings.
Therefore, the investigators would like to determine whether it is helpful among women who
sometimes drink 4 or more drinks per occasion or 7 or more drinks per week. The investigators
hypothesize that by taking naltrexone, women with hazardous drinking pattern will reduce
their drinking which in turn will improve their medication adherence, improve their health
and quality of life.
The primary objective of this study is to evaluate the acceptability and effectiveness of a
treatment program for hazardous drinking, delivered within HIV-clinic outpatient settings,
that involves oral naltrexone. The central hypothesis is that women randomized to the
treatment program will have decreased rates of hazardous drinking and improved clinical and
behavioral health outcomes that are associated with hazardous drinking. The investigators
have formulated this hypotheses based on the existing literature, the preliminary data and
the clinical experience. The investigators hypothesize that women randomized to receive an
alcohol treatment intervention will be less likely to have hazardous drinking behavior
6-months after enrollment, compared to women who received similar assessments but no formal
treatment intervention. The investigators hypothesize that 4-months after enrollment, women
randomized to receive an alcohol treatment intervention will have improved adherence to HIV
antiretroviral therapy, improved CD4 cell counts, reduced HIV viral load, and reduced risky
sexual behavior, compared to women who receive similar assessments but no formal
intervention.
The investigators will recruit 90 women from 3 different sites in Florida, Washington DC and
Chicago. Of those 90 women 60 will receive naltrexone and 30 will receive placebo. Study
participants will take the medication for 4 months but the investigators will follow them for
7 months. At baseline, 2 months, 4 months and 7 months, the investigators will administer
study questionnaires and assess their liver enzymes, CD4 count and viral load. The
investigators will also follow them up at month 1 and 3 to reinforce the medication intake
and to assess for any possible side effects.
New treatment options are available, but their impact on hazardous drinking has not yet been
evaluated among HIV-infected women, many of whom are poor, minorities, or who have associated
mental health or substance abuse problems. Delivery of therapeutic interventions must be
improved in order to reduce hazardous drinking in women with HIV/AIDS. The proposed research
is significant because the therapy will be offered within HIV clinic settings and will
potentially improve the health of a population that is significantly undertreated. In
addition to determining the effectiveness of an alcohol treatment intervention, the
investigators will also identify key barriers and facilitators associated with adherence to
pharmacologic treatment for alcohol in women with hazardous drinking. The findings will
directly impact the type and quality of care for hazardous drinking in this subset of
HIV-infected individuals and will inform both primary and secondary prevention efforts
treatment program for hazardous drinking, delivered within HIV-clinic outpatient settings,
that involves oral naltrexone. The central hypothesis is that women randomized to the
treatment program will have decreased rates of hazardous drinking and improved clinical and
behavioral health outcomes that are associated with hazardous drinking. The investigators
have formulated this hypotheses based on the existing literature, the preliminary data and
the clinical experience. The investigators hypothesize that women randomized to receive an
alcohol treatment intervention will be less likely to have hazardous drinking behavior
6-months after enrollment, compared to women who received similar assessments but no formal
treatment intervention. The investigators hypothesize that 4-months after enrollment, women
randomized to receive an alcohol treatment intervention will have improved adherence to HIV
antiretroviral therapy, improved CD4 cell counts, reduced HIV viral load, and reduced risky
sexual behavior, compared to women who receive similar assessments but no formal
intervention.
The investigators will recruit 90 women from 3 different sites in Florida, Washington DC and
Chicago. Of those 90 women 60 will receive naltrexone and 30 will receive placebo. Study
participants will take the medication for 4 months but the investigators will follow them for
7 months. At baseline, 2 months, 4 months and 7 months, the investigators will administer
study questionnaires and assess their liver enzymes, CD4 count and viral load. The
investigators will also follow them up at month 1 and 3 to reinforce the medication intake
and to assess for any possible side effects.
New treatment options are available, but their impact on hazardous drinking has not yet been
evaluated among HIV-infected women, many of whom are poor, minorities, or who have associated
mental health or substance abuse problems. Delivery of therapeutic interventions must be
improved in order to reduce hazardous drinking in women with HIV/AIDS. The proposed research
is significant because the therapy will be offered within HIV clinic settings and will
potentially improve the health of a population that is significantly undertreated. In
addition to determining the effectiveness of an alcohol treatment intervention, the
investigators will also identify key barriers and facilitators associated with adherence to
pharmacologic treatment for alcohol in women with hazardous drinking. The findings will
directly impact the type and quality of care for hazardous drinking in this subset of
HIV-infected individuals and will inform both primary and secondary prevention efforts
Inclusion Criteria:
- Hazardous drinking: defined by the NIAAA as either of the following:
1. binge drinking (4 or more drinks per occasion at least twice monthly), (NIAAA
2005) - OR
2. high quantity-frequency (>7 or drinks per week)
- Age 18 or over
- Female
- HIV-infected documented by a rapid HIV test or any licensed ELISA test kit and
confirmed by a repeat ELISA, Western Blot, HIV-1 culture, HIV-1 antigen, plasma HIV-1
RNA viral load or a second antibody test by a method other than ELISA at any time
prior to study entry.
- Able to understand and comply with planned study procedures.
- Willing and able to provide informed consent.
Exclusion Criteria:
- Contraindications to treatment with naltrexone: current physiologic opiate dependence;
current daily prescription opioid medications; positive urine drug test for opioids;
allergic to naltrexone; significantly abnormal baseline liver enzymes (AST or ALT ≥ 5
times normal); on dialysis for renal failure
- currently taking oral medications for tuberculosis.
- Currently pregnant or positive pregnancy test.
- currently breastfeeding.
- Currently taking an alcohol treatment medication (disulfiram, topiramate, naltrexone,
acamprosate).
- currently homeless, unable to provide mailing address, or has plans to move from area
within next 7 months.
- Unable to communicate in English.
- Research coordinator assessment that participant cannot comprehend the study or
consent procedures
- Has current prognosis of less than 1 year to live
- Abnormal vital signs at enrollment visit
- Currently on treatment for Hepatitis C (HCV) infection
- Prisoner status
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