HIV/AIDS is nearly five times more prevalent in US prisons than in the general population. Though adherence to antiretroviral treatment (ART) can be strictly monitored in correctional settings, clinical monitoring becomes problematic upon prisoners' release. Advertisement
Over a nine-year period, Dr. Nitika Pant Pai of the Research Institute of the McGill University Health Center and colleagues studied 512 HIV-positive repeat offender inmates from the San Francisco County jail system. They found that just 15 percent continuously took ART between incarcerations or after their releases. Inmates on intermittent therapy were 1.5 times more likely to have higher viral loads than those on continuous therapy, while those who never received ART were three times more likely to have a higher viral load.
"Taking ART intermittently is a problem because it depletes the CD4 count -- the immunizing cells that fight infection -- and increases the probability of developing resistance to the virus," said Pant Pai. "The risk for rapid disease progression becomes higher and presents a risk for public health transmission of HIV to their partners."
Study co-author Dr. Milton Estes, medical director of the San Francisco-based Forensic AIDS Project, said ensuring continuous ART is essential to controlling the US epidemic. "To achieve this we must work on various aspects of the prisoners' lives, such as marginalization, psychiatric problems and drug use, both before and after their departure from prison," he said.
The study "demonstrates the need for effective community transition and prison release programs to optimize ART given in jails," the researchers concluded.
The report, "The Impact of Antiretroviral Therapy in a Cohort of HIV Infected Patients Going in and out of the San Francisco County Jail
," was published online in the journal Public Library of Science ONE
Back to other news for October 2009