The U.S. criminal justice system is disproportionately impacted by people both HIV and substance use disorders, including alcohol abuse. Indeed, 26% of all HIV+ individuals, the majority of whom also have substance use disorders, cycle through the correctional system each year. HIV-infected prisoners with alcohol abuse face many obstacles as they transition back to the community. Specifically, they have impressive HIV treatment outcomes while incarcerated and free from alcohol, but face inordinate challenges that if not adequately addressed, result in significant morbidity and mortality. Recent data from randomized controlled trials affirm the role of pharmacotherapy with naltrexone (NTX) as the therapeutic option conferring the best outcome for alcohol dependence. Absent from these trials were inclusion of HIV-infected individuals. Released HIV+ prisoners who relapse to alcohol and drug use are less likely to adhere to HIV treatments, including antiretroviral therapy and engage in high levels of HIV risk behaviors. As a consequence, untreated alcohol dependence thereby has both negative HIV consequences for the individual and for society. We therefore propose to conduct a randomized, placebo-controlled trial of depot-NTX in 125 HIV+ prisoners with alcohol dependence as they transition to the community. After 2:1 randomization to d-NTX or placebo, all subjects will receive comprehensive case management services and 24 weeks of standardized counseling. D-NTX or placebo will be administered for 48 weeks. Outcomes of interest will include those related to HIV treatment (proportion with HIV-1 RNA<400, mean change in HIV-RNA, changes in CD4 count and retention in care), alcohol treatment (mean time to relapse, percent days abstinent, percent days drinking and craving), adverse side effects (in accordance with NIH guidelines for NTX) and HIV risk behaviors (mean number of sexual and drug use risky events) and a number of process measures. Findings from this trial will inform three major areas of scientific deficit for d-NTX: 1) determination of HIV treatment and risk behavior outcomes;2) determination of adverse side effects of d-NTX in HIV+ individuals using the placebo controlled trial study design;and 3) establishing d-NTX as an evidence-based intervention for released HIV+ prisoners. From a societal perspective, this study will confirm the benefits of linking treatment with prevention to optimize treatment outcomes for two conditions using pharmacological therapy for one.

Public Health Relevance

The public health relevance is that the outcomes from this study will establish the efficacy, safety and tolerability of pharmacological therapy using naltrexone treatment among HIV+s and establish depot-naltrexone treatment as an effective, evidence-based treatment for alcohol dependence for released HIV+ prisoners - a population who shares a disproportionate burden of morbidity and mortality and has fared poorly using the existing standard of care.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Special Emphasis Panel (ZAA1-EE (07))
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Roach, Deidra
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Yale University
Internal Medicine/Medicine
Schools of Medicine
New Haven
United States
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Vagenas, Panagiotis; Di Paola, Angela; Herme, Maua et al. (2017) Corrigendum to 'An evaluation of hepatic enzyme elevations among HIV-infected released prisoners enrolled in two randomized placebo-controlled trials of extended release naltrexone' [Journal of Substance Abuse Treatment 47 (2014) 35-40]. J Subst Abuse Treat 77:44
Springer, Sandra A; Di Paola, Angela; Azar, Marwan M et al. (2017) Extended-release naltrexone reduces alcohol consumption among released prisoners with HIV disease as they transition to the community. Drug Alcohol Depend 174:158-170
Rich, Josiah D; Beckwith, Curt G; Macmadu, Alexandria et al. (2016) Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis. Lancet 388:1103-1114
Dolan, Kate; Wirtz, Andrea L; Moazen, Babak et al. (2016) Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees. Lancet 388:1089-1102
(2016) Erratum to “Correlates of retention on extended-release naltrexone among persons living with HIV infection transitioning to the community from the criminal justice system” [Drug Alcohol Depend. 157 (2015) 158–165] Drug Alcohol Depend 161:372
Krishnan, Archana; Brown, Shan-Estelle; Ghani, Mansur A et al. (2016) Pretreatment drug use characteristics and experiences among patients in a voluntary substance abuse treatment center in Malaysia: A mixed-methods approach. Subst Abus 37:542-549
Ferguson, Warren J; Cloud, David; Spaulding, Anne C et al. (2016) A Call to Action: A Blueprint for Academic Health Sciences in the Era of Mass Incarceration. J Health Care Poor Underserved 27:5-17
Springer, Sandra A; Brown, Shan-Estelle; Di Paola, Angela et al. (2015) Correlates of retention on extended-release naltrexone among persons living with HIV infection transitioning to the community from the criminal justice system. Drug Alcohol Depend 157:158-65
Krishnan, Archana; Ferro, Enrico G; Weikum, Damian et al. (2015) Communication technology use and mHealth acceptance among HIV-infected men who have sex with men in Peru: implications for HIV prevention and treatment. AIDS Care 27:273-82
Vagenas, Panagiotis; Azar, Marwan M; Copenhaver, Michael M et al. (2015) The Impact of Alcohol Use and Related Disorders on the HIV Continuum of Care: a Systematic Review : Alcohol and the HIV Continuum of Care. Curr HIV/AIDS Rep 12:421-36

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