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Step-by-step treatment reduces drinking in HIV patients

People with HIV who drink too much are more likely to reduce alcohol consumption after undergoing a care approach known as integrated alcohol treatment, according to a Yale study.

The result supports the wider use of this treatment model in HIV clinics to improve outcomes for patients with both HIV and drinking problems.

The study was published in The Lancet HIV.

Gradual care is used to treat some patients with chronic illnesses such as hypertension and depression. It involves the use of various treatments that are "enhanced" or increased during intensity in response to patients' needs. Before this new study, few studies have been conducted to assess the impact of enhanced care for patients who have been struggling with alcohol-related disorders and none has been conducted in HIV care facilities.

The research team raised 128 people from one of the five Veterans-based HIV clinics. They randomized patients into one of the two groups – those who were given integrated alcohol alcohol treatment and an equal number of patients treated as usual.

Caregivers have offered evidence-based treatments, including medication, motivational therapy and special care in an outpatient or residential health care facility. For comparison, patients treated as regular patients were targeted at the treatment of VA addiction at the discretion of their HIV clinician.

At the end of the study period, the researchers found that patients who received integrated care improved better overall. After 52 weeks, retired patients had fewer days of heavy drinking, drinking less per day of drinking and had more days of abstinence, the researchers said.

"We have seen total improvements in drinking," says Jennifer Edelman, principal author and associate professor of internal medicine. "We also found improved HIV scores for a 52-week mark."

Improvements in patients' HIV status are probably related to reduced alcohol use, Edelman notes. "Over time, patients taking integrated care show a decrease in alcohol use and a higher rate of undetectable HIV viral load, possibly related to improved adherence to HIV drugs," she said.

The results of the study support the expansion of the use of integrated care for alcohol abuse in places where patients are already being treated with HIV.

The chief investigator was David Phillin. Other authors of the study include Stefan Maisto, Nathan Hansen, Christopher Cutter, James Juray, Yanghong Deng, Lin Phileen, Patrick O'Connor, Roger Bedemo, Cynthia Gibbert, Vincent Markony, David Richland, Maria Rodriguez-Barradas, Michael Simbercoff, Janet Tate, Amy Justice and Kendall Bryant.

This work was supported by grants from the National Institute on Alcohol Abuse and Alcoholism. Edelman is supported as a scientific scholar on drug abuse, HIV and drug addiction.

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