HIV Tx in Prison Improves Viral Load
(HealthDay News) — Optimization of HIV treatment regimens during incarceration results in the majority of prisoners achieving viral suppression by release, according to a study published online March 31 in JAMA Internal Medicine.
Jaimie P. Meyer, MD, from Yale University School of Medicine in New Haven, CT, and colleagues retrospectively reviewed demographic, pharmacy, and laboratory data from 882 prisoners within the Connecticut Department of Correction (200–52012) with confirmed HIV infection. The prisoners were continually incarcerated ≥90 days, had at least two HIV-1 RNA and CD4 lymphocyte measurements, and were prescribed antiretroviral therapy (ART).
The researchers found that the mean HIV-1 RNA level decreased by 1.1log10 and CD4 lymphocyte count increased by 98cells/µL over time. A higher proportion of prisoners achieved viral suppression by release compared with entry (70.0 vs. 29.8%; P<0.001). During incarceration, 36.9% of ART regimens were changed. Prerelease viral suppression correlated with female sex (adjusted odds ratio [aOR], 1.81) and psychiatric disorder severity below the sample median (aOR, 1.50), but not race/ethnicity, incarceration duration, ART regimen or dosing strategy, or directly observed therapy, when adjusting for baseline HIV-1 RNA level.
"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," the authors write.
The study was funded in part by Bristol Myers-Squibb.