High mortality among male HIV-infected patients after prison release: ART is not enough after incarceration with HIV

Abstract

ContextFrench Guiana is a South American French territory, where HIV prevalence consistently exceeds 1% in the adult population. In the only correctional facility, HIV prevalence fluctuates at around 4%.AimsAfter describing the population of HIV-positive inmates, we aimed to evaluate mortality after release from the correctional facility, and to identify its predictive factors.RationaleOutside North American settings, data on treatment outcome and vital status of HIV-positive former inmates are scarce. There were no data in French Guiana. Filling this gap represents a basis for potential improvements.MethodsAll HIV-infected adults released from an incarceration of 30 days or more, between 2007 and 2013, were enrolled in a retrospective cohort study. Mortality was described over time, one to seven years following release, using Kaplan-Meier estimates. Factors associated with mortality were identified through a non-parametric survival regression model.Results147 former inmates were included. The male to female ratio was 4.4. The median age was 37.3 years. The majority were migrants, 25.8% were homeless, 70.1% suffered from substance abuse, with 34.0% of crack-cocaine users. On admission, 78.1% had an early HIV-stage infection (CDC-stage A), with a median CD4 count of 397.5/mm3, 34.0% had one comorbidity, mainly hypertension. Upon release, 50.3% were on ART. Reasons for not being treated were not fulfilling the criteria for 74.6%, and refusing for 15.1%. Before release, 84.5% of the patients on ART had a viral load≤200cp/ml. After release, 8.2% of the cohort had died, with a crude incidence of 33.8/1000 person-years. All recorded deaths were males, with an incidence of 42.2/1000 person-years. Comparing with the age-specific mortality rates for males in French Guiana, the standardized mortality ratio was 14.8. In multivariate analysis, factors associated with death were age and CD4 count before release.ConclusionDespite access to ART while incarcerated, with good virological outcome, the post-release mortality was very high for males, almost 15 times what is observed in the general male population living in French Guiana, after age standardization. Access to ART in correctional facilities may be a necessary, but not sufficient condition to protect male inmates from death after release.

High prevalence rates for multiple psychiatric conditions among inmates at French Guiana’s correctional facility: diagnostic and demographic factors associated with violent offending and previous incarceration

“…However, here we did not find any significant association perhaps because violence between drug users may be less frequently reported to the police and less frequently prosecuted. Prison is likely to represent an opportunity to initiate addiction treatment and medical services that should aim for a smooth transition with the services outside of prison [ 19 , 20 ].…”

Prevalence and predictors of penile nodules in French Guiana's sole prison facility

“…The HIV prevalence in prison oscillates between 4 and 5% in French Guiana. There is a very high mortality among HIV-patients discharged from prison[ 10 ]. If 29.6% of detainees have penile nodules this implies that condom use will be difficult and therefore there will be an increased risk for acquiring and transmitting HIV.…”

“…They may also be associated with increased risk of sexually transmitted infections, condom rupture and sexual partner injury. [ 2 ] In the context of French Guiana, where HIV infection is prevalent[ 9 ], notably among inmates, where it is associated with poor outcomes[ 10 ], penile nodules may thus present an additional risk. In addition, they are a frequent cause of emergency calls for interventions ranging from suturing at the prisons medical facility to medical evacuation when deep vascular lesions and uncontrolled bleeding require surgical exploration.…”

Mapping priority neighborhoods: A novel approach to cluster identification in HIV/AIDS population

“…Research has shown that neighborhood crime was associated with HIV risk taking behaviors such as unprotected sex and multiple sexual partnerships (11,12). Furthermore, a recent study observed that HIV-related mortality reached over 8% of released prison inmates in FG (13).…”