title: High rate of resistance to antiretroviral drugs among HIV-infected prison inmates.
abstract: BACKGROUND
  Resistance to antiretroviral (ARV) drugs represents a major obstacle to the success of HIV therapy. The aim of the study was to examine the prevalence of genotypic resistance to ARV drugs in a large group of HIV-infected individuals incarcerated in penal facilities.
  
  
  METHODS
  We analyzed the reverse transcriptase and protease genes on plasma samples collected from 309 HIV-infected prison inmates in Madrid. In order to compare the prevalence of resistance at different periods and detect any trend over time, half of the samples from ARV-naive and half from pre-treated subjects were randomly collected in 1999 and in 2001.
  
  
  RESULTS
  Overall, 63.7% of specimens harbored plasma HIV-RNA above 1000 copies/ml. Genotypic data were obtained in 94.4% of them. Primary resistance mutations among 127 drug-naive subjects were recognized in 13% in 1999 vs. 15% in 2001. In contrast, drug resistance was found in 35% and 59% of 182 pre-treated subjects in 1999 and 2001.
  
  
  CONCLUSIONS
  Drug resistance has increased over the last two years among inmates on ARV drugs and currently affects 59% of those failing treatment. A nearly 3-fold increase has been noticed for NNRTI resistance. In comparison with HIV-positive subjects outside jail on ARV drugs, prisoners are more likely to experience virological failure, but show a lower rate of drug resistance; this affects particularly drugs with a low genetic barrier (i.e. NNRTI and 3TC).
authors.affiliation: Service of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Gallego
authors.forename: Angelica
authors.initials: A
authors.lastname: Corral
authors.forename: Carmen
authors.initials: C
authors.lastname: De Mendoza
authors.forename: Juan
authors.initials: J
authors.lastname: Gonzalez-Lahoz
authors.forename: Vincent
authors.initials: V
authors.lastname: Soriano
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D010450:Endopeptidases / Q000097:blood; D006678:HIV / Q000187:drug effects / Q000235:genetics*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D009154:Mutation; D011329:Prisoners; D012367:RNA, Viral / Q000097:blood / Q000302:isolation & purification; D012194:RNA-Directed DNA Polymerase / Q000097:blood; D012189:Retrospective Studies; D013030:Spain; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D012194:RNA-Directed DNA Polymerase; D010450:Endopeptidases