HIV treatment while incarcerated helped prisoners achieve viral suppression
Treating inmates for the human immunodeficiency virus (HIV) while they were incarcerated in Connecticut helped a majority of them achieve viral suppression by the time they were released.
Of the 1.2 million people living with HIV in the United States, about one-sixth of them will be incarcerated annually, and HIV prevalence is three-fold greater in prisons compared with community settings.
The authors evaluated HIV treatment outcomes during incarceration by studying 882 HIV-infected prisoners with 1,185 incarceration periods in the Connecticut Department of Corrections (2005-2012). The inmates were incarcerated for at least 90 days, had laboratory results regarding their infection, and were prescribed antiretroviral therapy (ART). Most of the inmates were men with an average age of nearly 43 years. Almost half were black.
While 29.8 percent of inmates began their incarceration having already achieved viral suppression (HIV viral load <400 copies/ml), 70 percent of the inmates achieved viral suppression before release. Viral suppression was attained regardless of age, race/ethnicity, duration of incarceration or type of ART regimen.
"Treatment for HIV within prison is facilitated by a highly structured environment and, when combined with simple well-tolerated ART regimens, can result in viral suppression during incarceration." Jaimie P. Meyer, M.D., of the Yale University School of Medicine, New Haven, Conn., and colleagues wrote in their paper.
In a related commentary, Michael Puisis, D.O., a correctional consultant from Evanston, Ill., writes: "Unfortunately, the features of the excellent correctional care provided to HIV-infected persons in this Connecticut system are not available to all of the estimated 20,000 HIV-infected persons incarcerated in federal or state facilities."
"While the Connecticut study is a positive accomplishment, HIV care in correctional centers still needs improvement in several areas," Puisis continues.
"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," Puisis concludes.
JAMA Intern Med. Published online March 31, 2014. DOI: 10.1001/jamainternmed.2014.521