Few HIV-positive prisoners in the US continue to take HIV treatment once they are released from jail, Canadian and US investigators report in the online journal PLoS One.
“We are concerned about the deleterious effects of intermittent therapy in light of the SMART data and the possibility of the development of resistance”, comment the investigators.
They continue, “our study…highlights the need to support continuous antiretroviral therapy and the importance of continuity of care services for HIV infected persons who enter the cycle of incarceration.”
HIV is a significant health problem in US prisons especially as it has been estimated that up to a quarter of HIV-positive individuals in the US will be imprisoned at some point.
Prisons are an important site of HIV care, which should be provided in accordance with US treatment guidelines. However, many individuals who initiate HIV treatment whilst incarcerated are unable or unwilling to continue their therapy after their release.
There is little information on the effects of antiretroviral therapy for prison inmates. Investigators therefore performed a retrospective study involving 512 individuals who were imprisoned in the San Francisco county jail over a ten-year period between 1996 and 2005.
Information was obtained on their use of antiretroviral therapy and changes in their CD4 cell count and viral load.
All the individuals were incarcerated at least twice (median five instances), with each sentence averaging a little over three months. Just over half of the prisoners (51%) were African American, and the vast majority (86%) were male.
Over three-quarters (76%) of individuals interrupted their HIV treatment after their release from prison. Only 15% took continuous HIV treatment and 9% refused antiretrovirals altogether.
Individuals taking continuous or intermittent HIV treatment had longer median periods of follow-up in jail than those who never took HIV treatment (38 vs 40 vs 26 months, p
Unsurprisingly, viral load was significantly higher over time in patients who never took HIV treatment (p
Differences were also observed in CD4 cell count, with patients who took continuous HIV treatment gaining approximately 1 CD4 cell per month of treatment, compared to a loss of approximately two cells per month amongst patients who interrupted their treatment or never initiated antiretroviral therapy.
“This study demonstrates that there is a clear benefit for continuous antiretroviral therapy in a group of persons going in and out of jail on both CD4 cell count and viral load especially compared to those who refuse antiretroviral therapy”, comment the investigators.
They conclude, “to maintain the benefit of antiretroviral therapy outside jails, effective community transition and prison release programs that focus on antiretroviral therapy management along with linkages to community providers, stabilization of housing, and community based support services are needed.”
Pant Pai N et al. The impact of antiretroviral therapy in a cohort of HIV infected patients going in and out of the San Francisco County jail. PLoS One 4 (9), 2009.