Connecticut Inmates With HIV Benefited From Treatment in Prison

This article was reported by Healio.

Healio reported on a study of HIV treatment of prison inmates. Jaimie, P. Meyer, MD, of the infectious diseases section of Yale School of Medicine, and colleagues evaluated HIV viral suppression, defined as HIV-1 RNA levels less than 400 copies per milliliter, in 882 HIV-positive inmates confined for 90 days or more in Connecticut Department of Corrections' jails and prisons during 2005-2012. The researchers reviewed data from the correctional facilities' databases, laboratories, and pharmacies to investigate changes in viral load before and after confinement and changes in CD4 counts.

The majority of inmates (47.4 percent) received protease inhibitor-based antiretroviral therapy (ART), and 38.6 percent received non-nucleoside reverse transcriptase inhibitors-based ART. Health practitioners changed approximately 37 percent of treatments during incarceration.

Findings indicated that HIV-1 RNA level decreased and mean CD4 cell count increased. Less than one-third (29.8 percent) of inmates had viral suppression before confinement, compared with 70 percent with viral suppression when released. Factors associated with achieving viral suppression were female sex and less severe psychiatric disorder. The researchers concluded that the ART regimens and successful treatment management at the correctional facilities improved the HIV-infected inmates' health.

Michael Puisis, DO, a correctional consultant in Evanston, Ill., in an accompanying editorial commented that the care the inmates in this study received is not available to all of the HIV-positive inmates in the United States. He contended that "HIV care in correctional centers still needs improvement in several areas." Puisis listed several areas such as HIV screening, continuity of care, and substance abuse, which should be treated while individuals are incarcerated and can have supervised medical care with discharge plans to maintain these benefits. If not, he warned the problem will worsen while the inmate is imprisoned and spread to the community after release.

The full report, "Optimization of Human Immunodeficiency Virus Treatment During Incarceration -- Viral Suppression at the Prison Gate," was published online in JAMA Internal Medicine (2014; doi:10.1001/jamainternmed.2014.601).