Effectiveness of naltrexone treatment for alcohol use disorders in HIV: a systematic review

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Abstract

Background

Because alcohol use disorders (AUDs) in patients living with HIV/AIDS are associated with a reduction in therapeutic outcomes and increases the risk of morbidity/mortality, finding an appropriate pharmacotherapy treatment for this disorder is necessary.

Objectives

This systematic review contains studies that examine the effects of pharmacological intervention (oral naltrexone (NTX) or injectable extended-release naltrexone (XR-NTX)) on the persons living with HIV and AUDs.

Methods

A systematic literature search using three electronic databases including Pubmed Medline, Scopus and the Cochrane Library and Google Scholar was conducted and includes articles published from 1995 to 2019. Records were collected by searching relevant keywords and those that meet the inclusion/exclusion criteria are included.

Results

Overall, in this systematic review, the results of 7 relevant studies including pilot and randomized controlled/clinical trials were summarized and reviewed. Among selected records 2 of these assessed the efficacy of NTX and 5 tested the XR-NTX effectiveness in treating AUDs among persons living with HIV (PLH). In summary, with some expectations, NTX and XR-NTX administration in persons living with HIV and AUDs led to reduced alcohol use, improved viral suppression, unchanged ART adherence and has no significant adverse events.

Conclusion

The findings of this systematic review suggest the beneficial effects and safety of the NTX and XR-NTX for treating AUDs in PLH. Further studies are needed in the future to focus on the treatment of AUDs in people living with HIV.

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Most cited references 36

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The prevalence of hepatitis C virus infection in the United States, 1999 through 2002.

Gregory Armstrong, Annemarie Wasley, Edgar Simard … (2006)

Defining the primary characteristics of persons infected with hepatitis C virus (HCV) enables physicians to more easily identify persons who are most likely to benefit from testing for the disease. To describe the HCV-infected population in the United States. Nationally representative household survey. U.S. civilian, noninstitutionalized population. 15,079 participants in the National Health and Nutrition Examination Survey between 1999 and 2002. All participants provided medical histories, and those who were 20 to 59 years of age provided histories of drug use and sexual practices. Participants were tested for antibodies to HCV (anti-HCV) and HCV RNA, and their serum alanine aminotransferase (ALT) levels were measured. The prevalence of anti-HCV in the United States was 1.6% (95% CI, 1.3% to 1.9%), equating to an estimated 4.1 million (CI, 3.4 million to 4.9 million) anti-HCV-positive persons nationwide; 1.3% or 3.2 million (CI, 2.7 million to 3.9 million) persons had chronic HCV infection. Peak prevalence of anti-HCV (4.3%) was observed among persons 40 to 49 years of age. A total of 48.4% of anti-HCV-positive persons between 20 and 59 years of age reported a history of injection drug use, the strongest risk factor for HCV infection. Of all persons reporting such a history, 83.3% had not used injection drugs for at least 1 year before the survey. Other significant risk factors included 20 or more lifetime sex partners and blood transfusion before 1992. Abnormal serum ALT levels were found in 58.7% of HCV RNA-positive persons. Three characteristics (abnormal serum ALT level, any history of injection drug use, and history of blood transfusion before 1992) identified 85.1% of HCV RNA-positive participants between 20 and 59 years of age. Incarcerated and homeless persons were not included in the survey. Many Americans are infected with HCV. Most were born between 1945 and 1964 and can be identified with current screening criteria. History of injection drug use is the strongest risk factor for infection.

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Naltrexone in the treatment of alcohol dependence.

J R Volpicelli, A I Alterman, M Hayashida … (1992)

Seventy male alcohol-dependent patients participated in a 12-week, double-blind, placebo-controlled trial of naltrexone hydrochloride (50 mg/d) as an adjunct to treatment following alcohol detoxification. Subjects taking naltrexone reported significantly less alcohol craving and days in which any alcohol was consumed. During the 12-week study, only 23% of the naltrexone-treated subjects met the criteria for a relapse, whereas 54.3% of the placebo-treated subjects relapsed. The primary effect of naltrexone was seen in patients who drank any alcohol while attending outpatient treatment. Nineteen (95%) of the 20 placebo-treated patients relapsed after they sampled alcohol, while only eight (50%) of 16 naltrexone-treated patients exposed to alcohol met relapse criteria. Naltrexone was not associated with mood changes or other psychiatric symptoms. Significant side effects (nausea) occurred in two naltrexone-treated subjects, and one naltrexone-treated subject complained of increased pain from arthritis. These results suggest that naltrexone may be a safe and effective adjunct to treatment in alcohol-dependent subjects, particularly in preventing alcohol relapse.

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Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial.

Helen Pettinati, Stephanie O’Malley, W. Ehrich … (2005)

Alcohol dependence is a common disorder associated with significant morbidity and mortality. Naltrexone, an opioid antagonist, has been shown to be effective for treatment of alcohol dependence. However, adherence to daily oral pharmacotherapy can be problematic, and clinical acceptance and utility of oral naltrexone have been limited. To determine efficacy and tolerability of a long-acting intramuscular formulation of naltrexone for treatment of alcohol-dependent patients. A 6-month, randomized, double-blind, placebo-controlled trial conducted between February 2002 and September 2003 at 24 US public hospitals, private and Veterans Administration clinics, and tertiary care medical centers. Of the 899 individuals screened, 627 who were diagnosed as being actively drinking alcohol-dependent adults were randomized to receive treatment and 624 received at least 1 injection. An intramuscular injection of 380 mg of long-acting naltrexone (n = 205) or 190 mg of long-acting naltrexone (n = 210) or a matching volume of placebo (n = 209) each administered monthly and combined with 12 sessions of low-intensity psychosocial intervention. The event rate of heavy drinking days in the intent-to-treat population. Compared with placebo, 380 mg of long-acting naltrexone resulted in a 25% decrease in the event rate of heavy drinking days (P = .02) [corrected] and 190 mg of naltrexone resulted in a 17% decrease (P = .07). Sex and pretreatment abstinence each showed significant interaction with the medication group on treatment outcome, with men and those with lead-in abstinence both exhibiting greater treatment effects. Discontinuation due to adverse events occurred in 14.1% in the 380-mg and 6.7% in the 190-mg group and 6.7% in the placebo group. Overall, rate and time to treatment discontinuation were similar among treatment groups. Long-acting naltrexone was well tolerated and resulted in reductions in heavy drinking among treatment-seeking alcohol-dependent patients during 6 months of therapy. These data indicate that long-acting naltrexone can be of benefit in the treatment of alcohol dependence.

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Author and article information

Contributors

Maryam Farhadian: maryam_farhadian80@yahoo.com

Mohsen Shahlaei: m.shahlaei@kums.ac.ir , mohsenshahlaei@yahoo.com

Journal

Journal ID (nlm-ta): Subst Abuse Treat Prev Policy

Journal ID (iso-abbrev): Subst Abuse Treat Prev Policy

Title: Substance Abuse Treatment, Prevention, and Policy

Publisher: BioMed Central (London )

ISSN (Electronic): 1747-597X

Publication date (Electronic): 18 March 2020

Publication date PMC-release: 18 March 2020

Publication date Collection: 2020

Volume: 15

Electronic Location Identifier: 24

Affiliations

[1 ]GRID grid.412112.5, ISNI 0000 0001 2012 5829, Substance Abuse Prevention Research Center, Health Institute, , Kermanshah University of Medical Sciences, ; Kermanshah, Iran

[2 ]GRID grid.412112.5, ISNI 0000 0001 2012 5829, Nano Drug Delivery Research Center, Health Technology Institute, , Kermanshah University of Medical Sciences, ; Kermanshah, Iran

[3 ]GRID grid.412112.5, ISNI 0000 0001 2012 5829, Department of Infection Disease, Faculty of Medicine, , Kermanshah University of Medical Sciences, ; Kermanshah, Iran

[4 ]GRID grid.412112.5, ISNI 0000 0001 2012 5829, Clinical Research Development Center, Imam Reza Hospital, , Kermanshah University of Medical Sciences, ; Kermanshah, Iran

[5 ]GRID grid.412112.5, ISNI 0000 0001 2012 5829, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, , Kermanshah University of Medical Sciences, ; Kermanshah, Iran

[6 ]GRID grid.411950.8, ISNI 0000 0004 0611 9280, Department of Biostatistics, School of Public Health and Research Center for Health Sciences, , Hamadan University of Medical Sciences, ; Hamadan, Iran

Article

Publisher ID: 266

DOI: 10.1186/s13011-020-00266-6

PMC ID: 7081595

PubMed ID: 32188486

SO-VID: 17ce7bb3-19f2-4e42-b7d4-d1d9a14c1867

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 21 December 2019

Date accepted : 10 March 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100012286, Deputy for Research and Technology, Kermanshah University of Medical Sciences;

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: alcohol use disorders (auds),hiv,naltrexone,systematic review,treatment

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: alcohol use disorders (auds), hiv, naltrexone, systematic review, treatment

Effectiveness of naltrexone treatment for alcohol use disorders in HIV: a systematic review

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Abstract

Background

Objectives

Methods

Results

Conclusion

Related collections

Tobacco Prevention & Cessation

Most cited references 36

The prevalence of hepatitis C virus infection in the United States, 1999 through 2002.

Naltrexone in the treatment of alcohol dependence.

Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial.

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