The highly structured environment of prison facilitates HIV treatment and may have helped a majority of prisoners with the disease achieve viral suppression by the time they were released, according to new study data.
“Among the 1.2 million people living with HIV/AIDS in the United States, one-sixth cycle through correctional settings annually …” Jaimie P. Meyer, MD, of the infectious diseases section of Yale School of Medicine, and colleagues wrote in JAMA Internal Medicine. “The treatment needs of HIV-infected prisoners are protected by law, and HIV management in correctional settings can be acceptable, logistically feasible, and effective if care is adequately coordinated with HIV experts, especially when under court supervision.”
Jaimie P. Meyer
Meyer and colleagues assessed HIV viral suppression — defined as having HIV-1 RNA levels of less than 400 copies/mL — in 882 HIV-infected prisoners detained for at least 90 days in both jails and prisons in the Connecticut Department of Corrections (CTDOC) between 2005 and 2012. The researchers utilized integrated databases from correctional facilities, laboratories and pharmacies to study changes in prisoners’ viral load before and after incarceration, as well as changes in CD4 count over time.
The cohort contributed to 1,185 incarceration periods, with prison terms lasting on average around 1.5 years.
Most prisoners were prescribed protease inhibitor-based regimens for antiretroviral therapy (47.4%), followed by non-nucleoside reverse transcriptase inhibitors-based regimens (38.6%). Approximately 37% of ART regimens were changed during incarceration, lower than previous estimates for prisoners cycled through CTDOC.
The researchers found that the mean HIV-1 RNA level decreased over time by 1.12 log10 (P<.001), and the mean CD4 count increased by 98 cells/mL (P<.001). Less than one-third (29.8%) of prisoners achieved viral suppression before entering correctional facilities vs. 70% who left prison with undetectable viral loads (P<.001) — more than three times higher than people living with HIV in community-based settings.
Factors associated with achieving viral suppression before release included female sex (adjusted OR=1.81; 95% CI, 1.26-2.59) and lower psychiatric disorder severity compared with the sample median (adjusted OR=1.5; 95% CI, 1.12-1.99).
The researchers concluded that improved, well-tolerated ART regimens, along with the successful management of HIV treatment in correctional facilities in the state of Connecticut, led to improved health outcomes among prisoners.
In an accompanying editorial, Michael Puisis, DO, a correctional consultant in Evanston, Ill., wrote that although the results of the study were encouraging, the standard of care in the CTDOC is not available to all of the estimated 20,000 HIV-infected individuals who are incarcerated in the United States.
“While the Connecticut study is a positive accomplishment, HIV care in correctional centers still needs improvement in several areas,” Puisis wrote.
These include routine HIV screening for inmates, continuity of care and substance abuse treatment. Prison populations experience drug addiction, mental illness, infectious and chronic diseases and barriers to care, similar to the health problems of the poor in the United States, he added.
“Unless these issues are dealt with in prison, they will fester both inside the prison walls and outside in the community when the person is released,” Puisis wrote. “We should take fullest advantage of the incarceration period, when people can receive supervised treatment, to improve their health and to develop discharge plans that will maintain these benefits on the outside.”
For more information:
Meyer JP. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.601.
Puisis M. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.521.
Disclosure: The researchers report no relevant financial disclosures.