Effectiveness of Antiretroviral Therapy among HIV-Infected Prisoners: Reincarceration and the Lack of Sustained Benefit after Release to the Community

Abstract

Responses to highly active antiretroviral therapy (HAART) in correctional settings and their sustained benefit in prisoners after release are currently not known. To examine the human immunodeficiency virus type 1 (HIV-1) RNA level (VL) and CD4 lymphocyte response to HAART during incarceration and upon reentry to the correctional system, we conducted a retrospective cohort study of longitudinally linked demographic, pharmacy, and laboratory data from the Connecticut prison system. During incarceration, the mean CD4 lymphocyte count increased by 74 lymphocytes/ mu L, and the mean VL decreased by 0.93 log10 copies/mL (P<.0001). Fifty-nine percent of the subjects achieved a VL of <400 copies/mL at the end of each incarceration period. For the 27% of subjects who were reincarcerated, the mean CD4 lymphocyte count decreased by 80 lymphocytes/ mu L, and the mean VL increased by 1.14 log10 (P<.0001). Although HAART use resulted in impressive VL and CD4 lymphocyte outcomes during the period of incarceration, recidivism to prison was high and was associated with a poor outcome. More effective community-release programs are needed for incarcerated patients with HIV disease.

Antiretroviral Treatment Regimen Outcomes Among HIV-Infected Prisoners

“…8 The median time to the first VL <400 copies was 93 days and was similar for the PI, NNRTI, and NRTI-only regimens. There were no baseline or follow-up differences among the four treatment strategies with respect to VL and CD4.…”

Directly Observed versus Self-administered Antiretroviral Therapies: Preference of HIV-Positive Jailed Inmates in San Francisco

“…[33][34][35][36][37][38][39][40] Approximately 16.9% of all HIV-positive individuals are in the U.S. criminal justice system 41 ; therefore, interventions that improve ARV uptake, as well as ARV adherence and persistence after release from jails and prisons have the potential to curtail the HIV epidemic by decreasing HIV transmission to others. This is particularly relevant given the deleterious effect of short-term incarceration and release on virologic outcomes [42][43][44] and the high frequency of self-reported HIV-related risky behaviors of newly released HIV-positive inmates. [25][26][27][28][29][30] The dilemma facing providers in correctional facilities is how to best deliver therapies.…”

Transitions to Care in the Community for Prison Releasees with HIV: a Qualitative Study of Facilitators and Challenges in Two States

“…Discharge planning and transitional programs are critical to ensuring continuity of care, maintaining treatment outcomes achieved in prison, and preventing further viral transmission in the community. [2][3][4] However, effectively linking prison releasees to community-based services faces multiple challenges. These include assisting releasees to keep appointments and adhere to treatment regimens and managing co-morbid conditions such as mental illness and substance use.…”