The increased life expectancy of Patients Living With HIV/AIDS (PLWHA) has increased the need
for therapies for chronic conditions, such as chronic pain. Pain in the HIV population is
often refractory and ends up being treated with chronic opioids, which are associated with
adverse effects, including hyperalgesia, constipation, and risk of overdose. Naltrexone is an
opioid antagonist used in the treatment of alcohol and opioid use disorders. Low Dose
Naltrexone (LDN), naltrexone at a much lower dose, is thought to be an immune modulator and
has been associated with an increased CD4 count in PLWHA. Repurposing this medication is
relatively inexpensive, and has the potential to expand access to treatment for a painful
condition experienced in PLWHA. While there are many case reports on the efficacy of LDN in
symptom reduction, there are only a small number of clinical trials that specifically examine
pain and symptom relief.
This study will include patients who are not completely virologically controlled and will
monitor the CD4 counts drawn as a part of routine care. If the CD4 count improves with LDN
and with reduced symptoms, this could be a significant improvement in HIV therapy for symptom
control. There have been studies showing cytokine reduction in fibromyalgia patients but they
did not investigate the correlation with cytokines and pain relief. This study involves
repurposing of a drug used for substance use disorder to a medication with the potential to
treat pain and improve symptoms for PLWHA.