Off-Label Medications for Alcohol Use Disorder Among Patients With HIV: Pilot Study 1

Eligibility Criteria

• * diagnosed with HIV
• * Receive care at the Atlanta VA Healthcare System
• * Age 18 or over
• * Meet criteria for moderate to severe alcohol use disorder by the DSM-5 Alcohol Symptom Checklist
• * Score \>7 on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screen
• * Have evidence of significant alcohol use: PEth \> 20ng/ml
• * Prescribed \>=5 medications
• * Have cell phone or reliable contact number
• * Can provide written informed consent
• * Active engagement in formal alcohol treatment including medications for alcohol use disorder at the time of enrollment
• * Self-report or laboratory test confirming pregnancy, nursing, or trying to conceive
• * Life-threatening or unstable medical, surgical, or psychiatric condition that prohibits participation (including current or past intent to harm oneself or others within the prior 12 months and not receiving treatment
• * Untreated moderate to severe opioid use disorder
• * Residence out of state
• * Inability to read or understand English
• * History of serious hypersensitivity or adverse reaction to study medication
• * Taking potentially interactive medication(s): eplerenone, potassium supplementation, lithium, digoxin, cholestyramine, heparin and low-molecular weight heparin for spironolactone)
• * Hyperkalemia defined as serum potassium ≥ 5.0 mEq/L on the most recent laboratory test performed in the past 60 days prior to enrollment or Addison's disease or estimated glomerular filtration rate \<50 mL/min/1.73 m2 (for spironolactone)
• * Creatinine level of ≥1.5 mg/dl (for spironolactone)
• * Already prescribed the pilot medication at the time of study recruitment.