title: 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.
authors.affiliation: Yale AIDS Program, Yale University School of Medicine, New Haven, Connecticut 06510-2283, USA.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Springer
authors.forename: Edward
authors.initials: E
authors.lastname: Pesanti
authors.forename: John
authors.initials: J
authors.lastname: Hodges
authors.forename: Thomas
authors.initials: T
authors.lastname: Macura
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D015497:HIV-1; D006801:Humans; D011329:Prisoners; D011330:Prisons; D012189:Retrospective Studies; D019562:Viral Load