Abstract Archive

Extended-release naltrexone is associated with sustained virologic suppression among HIV+ prisoners with alcohol use disorders after release to the community

Background: For people living with HIV (PLH), alcohol use disorders (AUDs) are associated with poor immunologic and virologic outcomes. Prisoners with HIV lose HIV VL suppression they gained while incarcerated within 3 months post-release. We aimed to see if the use of extended-release naltrexone (XR-NTX), an effective treatment for AUDs, could maintain and/ or improve rates of VLS for PLH with AUDs after they are released from prison.
Methods: This is a double-blind placebo-controlled randomized trial of XR-NTX (randomized 2:1, XR-NTX: placebo) conducted among HIV+ prisoners with AUDs who were released to the community in Connecticut, U.S.A. Participants were administered 6 monthly injections given 1-2 weeks prior to release and monthly thereafter for 5 months post-release. The primary outcome was sustained virologic suppression at 6 months at < 400 copies/mL with additional secondary outcomes of proportion with VLS at < 200 and < 50.
Results: A total of 100 participants were randomized 2:1 (N=67 XR-NTX; N=33 Placebo). Baseline demographics were: 21% women, 37% homeless, 65% Black/African American, mean incarceration time period of 13 months, 50% with chronic HCV, 86% prescribed ART, and 90% with a CD4 >200. There was a statistically significant greater mean proportion of persons who had a VL UD at baseline who maintained a VL UD at 6 months in the XR-NTX group as compared to the placebo group at < 50 copies/ ML and < 200 copies/mL value, but not at the < 400 copies/mL value (see Table 1).

Viral Load (Copies/ml) by Treatment Arm	Baseline (%) (XR-NTX, PLC)	6 months (%) (XR-NTX, PLC)	Mean of the Differences	95% Confidence Interval	P value
<50 XR-NTX, Placebo	36,48	50, 34	0.212	0.740, 0.349	0.003*
<200 XR-NTX, Placebo	53, 72	55, 34	0.176	0.043,0.31	0.013*
<400 XR-NTX, Placebo	70, 72	63, 41	0.11	-0.027, 0.239	0.118

[Table 1: Comparisons of Percentages of VL suppression from baseline to 6 months by treatment arm based on Results of T Test analyses.]

Conclusions: Preliminary results from this RCT show that XR-NTX may help maintain VL suppression and/ or improve to achieve VL suppression as HIV+ prisoners transition to the community, thus a potential intervention to improve the HIV continuum of care for PLH with AUDs involved in the CJS.

S. Springer¹, M. Azar², R. Barbour³, F. Altice², A. Di Paola¹
¹Yale School of Medicine, Infectious Disease, New Haven, United States, ²Yale School of Medicine, Section of Infectious Disease/ Yale AIDS Program, New Haven, United States, ³Yale University School of Medicine, Center for Interdisciplinary Research on AIDS, New Haven, United States