Extended-Release Naltrexone Improves Viral Suppression Among Incarcerated Persons Living With HIV With Opioid Use Disorders Transitioning to the Community: Results of a Double-Blind, Placebo-Controlled Randomized Trial

Springer, Sandra A.; Paola, Angela Di; Azar, Marwan M.; Barbour, Russell; Biondi, Breanne E.; Desabrais, Maureen; Lincoln, Thomas; Skiest, Daniel J.; Altice, Frederick L.

doi:10.1097/qai.0000000000001634

Cited by 70 publications

(71 citation statements)

References 52 publications

(69 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Those who received XR-NTX were more likely to maintain or improve to viral suppression at 6 months (31 to 56.7%, p = 0.001) as compared to those who received placebo (42 to 30.3%, p = 0.292). The 6-month between-group analysis also demonstrated that those who received XR-NTX had a greater proportion with viral suppression (56.7%) as compared to the placebo group (30.3%, p = 0.015), and receipt of XR-NTX was associated with viral suppression at 6 months in multivariate regression analysis (AOR 4.54 (95% CI, 1.43–14.43, p = 0.009) [12•]. The other double-blind, placebo-controlled trial of XR-NTX among PLH with OUD released from prison and jail had 98 participants also randomized in 2:1 fashion (XR-NTX: placebo) with the same design as the previously mentioned study.…”

Section: Naltrexonementioning

confidence: 98%

“…This study suggests the risk of hepatotoxicity is minimal in HIV-infected participants treated with naltrexone, and that there are no adverse immunologic or virologic effects of treatment. The safety of extended-released naltrexone (XR-NTX) is further demonstrated in PLH randomized to XR-NTX following release from prison, who experienced no change in hepatic enzymes compared to those receiving placebo in two double-blind, placebo-controlled randomized trials in PLH with alcohol use disorders and those with opioid use disorders [41], nor in the completed trials themselves [12, 42, 43]. HIV/HCV co-infection has no effect on XR-NTX hepatic safety [44].…”

Section: Naltrexonementioning

confidence: 99%

“…Two recently completed double-blind randomized controlled trials among PLH being released from prison and jail in the USA with AUD and OUD, respectively, found that XR-NTX improved or maintained viral suppression at < 50 copies/mL 6 months after release [12, 42]. The first study among those with HIV and AUD had 100 participants randomized in a 2:1 fashion to receive XR-NTX or matched placebo injection starting 1 week prior to release from an incarcerated setting then five subsequent injections in the community.…”

Section: Naltrexonementioning

confidence: 99%

“…Providing MOUD with the opioid agonists methadone or buprenorphine can improve engagement and retention in care for persons living with HIV (PLH), receipt of antiretroviral therapy (ART), ART adherence, and HIV viral suppression [10•, 11, 12•]. MOUD also decreases illicit opioid use, HIV transmission [13], and mortality [14].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Medications for Treatment of Opioid Use Disorder among Persons Living with HIV

2019

Self Cite

View full text Add to dashboard Cite

Purpose of Review Recent HIVoutbreaks have occurred as a result of the current US opioid epidemic. Providing medications for opioid use disorder (MOUD) with methadone, buprenorphine, and extended-release naltrexone is essential to achieving optimal HIV treatment outcomes including viral suppression and retention in treatment. This review describes the pharmacology of MOUD with specific attention to interactions with antiretroviral therapy, and to the effect of MOUD on HIV treatment outcomes. Recent Findings Methadone and buprenorphine both improve HIV viral suppression, adherence to antiretroviral therapy, and overall mortality for persons with opioid use disorder (OUD). Extended-release naltrexone has been most extensively studied in persons with HIV leaving incarcerated settings, and improves HIV viral suppression in that context. Summary Strategies that integrate MOUD and HIV treatment are crucial to optimize viral suppression. The differing pharmacokinetic and delivery characteristics of these MOUD offer diverse options. Given the chronic and relapsing nature of both HIV and OUD, long-term approaches are required.

show abstract

Section: Naltrexonementioning

confidence: 98%

Section: Naltrexonementioning

confidence: 99%

Section: Naltrexonementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Medications for Treatment of Opioid Use Disorder among Persons Living with HIV

2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Evidence-based treatment of substance use disorders especially with medication-assisted treatments is seldom available, and in the absence of treatment, relapse is near-universal and undermine HIV care postrelease [25 ■■ ,62,67]. Unequivocal strategies that link relapse prevention using methadone [69,70], or buprenorphine [71,72] are recommended with newer emergent strategies using extended-release naltrexone that not only reduce opioid use in released prisoners [73], but also significantly improves HIV outcomes in released prisoners with HIV with alcohol [74] and opioid [75] dependence using placebo-controlled designs [76,77].…”

Section: Treatment Of Hiv and Hepatitis C Virus In Prisonmentioning

confidence: 99%

Prisons

Kamarulzaman

Verster

Altice

2019

Current Opinion in HIV and AIDS

Self Cite

View full text Add to dashboard Cite

Purpose of review-People with HIV and HCV are concentrated within criminal justice settings globally, primarily related to criminalization of drug use. This review examines updated prevention and treatment strategies for HIV and HCV within prison with a focus on people who inject drugs and the challenges associated with the provision of these services within prisons and other closed settings and transition to the community. Recent findings-The prevalence of HIV and HCV are several-fold higher in the criminal justice system than within the broader community particularly in regions with high prevalence of injecting drug use, such as Asia, Eastern Europe and North America and where drug use is criminalized. Strategies to optimize management for these infections include routine screening linked to treatment within these settings and medication-assisted treatments for opioid dependence and access to syringe services programs. We build upon the 2016 WHO Consolidated Guidelines through the lens of the key populations of prisoners. Linkage to treatment postrelease, has been universally dismal, but is improved when linked to medication-assisted therapies like methadone, buprenorphine and overdose management. In many prisons, particularly in low-income and middle-income settings, provision of even basic healthcare including mental healthcare and basic HIV prevention tools remain suboptimal. Summary-In order to address HIV and HCV prevention and treatment within criminal justice settings, substantial improvement in the delivery of basic healthcare is needed in many prisons worldwide together with effective screening, treatment and linkage of treatment and prevention services to medication-assisted therapies within prison and linkage to care after release.

show abstract

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Gandhi

Bedimo

Hoy

et al. 2023

JAMA

Self Cite

181

148

View full text Add to dashboard Cite

ImportanceRecent advances in treatment and prevention of HIV warrant updated recommendations to guide optimal practice.ObjectiveBased on a critical evaluation of new data, to provide clinicians with recommendations on use of antiretroviral drugs for the treatment and prevention of HIV, laboratory monitoring, care of people aging with HIV, substance use disorder and HIV, and new challenges in people with HIV, including COVID-19 and monkeypox virus infection.Evidence ReviewA panel of volunteer expert physician scientists were appointed to update the 2020 consensus recommendations. Relevant evidence in the literature (PubMed and Embase searches, which initially yielded 7891 unique citations, of which 834 were considered relevant) and studies presented at peer-reviewed scientific conferences between January 2020 and October 2022 were considered.FindingsInitiation of antiretroviral therapy (ART) is recommended as soon as possible after diagnosis of HIV. Barriers to care should be addressed, including ensuring access to ART and adherence support. Integrase strand transfer inhibitor–containing regimens remain the mainstay of initial therapy. For people who have achieved viral suppression with a daily oral regimen, long-acting injectable therapy with cabotegravir plus rilpivirine given as infrequently as every 2 months is now an option. Weight gain and metabolic complications have been linked to certain antiretroviral medications; novel strategies to ameliorate these complications are needed. Management of comorbidities throughout the life span is increasingly important, because people with HIV are living longer and confronting the health challenges of aging. In addition, management of substance use disorder in people with HIV requires an evidence-based, integrated approach. Options for preexposure prophylaxis include oral medications (tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine) and, for the first time, a long-acting injectable agent, cabotegravir. Recent global health emergencies, like the SARS-CoV-2 pandemic and monkeypox virus outbreak, continue to have a major effect on people with HIV and the delivery of services. To address these and other challenges, an equity-based approach is essential.Conclusions and RelevanceAdvances in treatment and prevention of HIV continue to improve outcomes, but challenges and opportunities remain.

show abstract

Extended-Release Naltrexone Improves Viral Suppression Among Incarcerated Persons Living With HIV With Opioid Use Disorders Transitioning to the Community: Results of a Double-Blind, Placebo-Controlled Randomized Trial

Abstract: XR-NTX improves or maintains VS after release to the community for incarcerated people living with HIV with OUD.

Cited by 70 publications

References 52 publications

Medications for Treatment of Opioid Use Disorder among Persons Living with HIV

Medications for Treatment of Opioid Use Disorder among Persons Living with HIV

Prisons

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Contact Info

Product

Resources

About