<p>Unhealthy alcohol use is prevalent among people with HIV (PWH) and associated with significant health-related consequences. We describe here a randomized feasibility/acceptability trial of a brief, telephone-delivered transdiagnostic acceptance and commitment therapy (ACT) intervention for PWH who drink at unhealthy levels. This pilot trail was designed to match the procedures of a planned definitive RCT that will compare the ACT intervention to a brief alcohol intervention (BI). We randomly assigned PWH and unhealthy alcohol use 1:1 to either the ACT or the BI intervention and collected self-report and biomarker data post-treatment and again at 3-, 6-, and 12-months. The primary objectives of this pilot trial were to assess feasibility of recruitment, retention, and intervention delivery, and acceptability of intervention content. We also collected preliminary primary (alcohol use) and secondary (symptoms of anxiety, depression, and experiential avoidance) outcome data to examine general patterns of results at a purely descriptive level. In total, 192 participants were screened, 117 of whom were eligible, and 49 of whom were randomized to either the ACT (<i>n</i> = 24) or BI (<i>n</i> = 25) condition. Results provided evidence of feasibility and acceptability indicating that a definitive trial should proceed. Preliminary outcome data also suggested that ACT is a promising treatment for unhealthy alcohol use and co-morbid symptoms of depression, anxiety, and experiential avoidance. A definitive trial is currently underway and will determine the comparative efficacy of ACT versus BI for unhealthy alcohol use for PWH.</p>