Effect of release from prison and re-incarceration on the viral loads of HIV-infected individuals.
OBJECTIVE
The purpose of this study was to determine the effect of release from prison and subsequent re-incarceration on the viral loads of HIV-infected individuals receiving highly active antiretroviral therapy (HAART).


METHODS
Fifteen re-incarcerated HIV-infected prisoners on HAART were identified from a retrospective cohort of HIV-infected prison inmates released from January 1, 1997, to August 31, 1999. The re-incarcerated prisoners were matched (1:2) to 30 HIV-infected incarcerated prisoners on HAART who remained incarcerated during the re-incarcerated participants' release time period. The outcomes measured were plasma HIV RNA levels, CD4+ lymphocyte counts, percentage of re-incarcerated and incarcerated participants with plasma HIV RNA levels <400 copies/mL, and the median change in plasma HIV RNA levels of the re-incarcerated and incarcerated participants at the end of the study.


RESULTS
At the beginning of the study, 8/15 re-incarcerated participants had plasma HIV RNA levels <400 copies/mL, compared with 15/30 incarcerated participants. At the end of the study, only three of those eight re-incarcerated participants had plasma HIV RNA levels <400 copies/mL, compared with 14/15 incarcerated participants (p=0.0086). The median change in plasma HIV RNA levels of the re-incarcerated participants was 1.29 log10 copies/mL (interquartile range 0.04 to 1.70), compared with -0.03 log10 copies/mL (interquartile range -0.65 to 0.09) in the incarcerated participants (p=0.0183).


CONCLUSIONS
Release from prison was associated with a deleterious effect on virological and immunological outcomes. These data suggest that comprehensive discharge planning efforts are required to make certain that HIV-infected inmates receive access to quality care following incarceration.
Stephenson
Becky L
BL
Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA. bls@med.unc.edu
Wohl
David A
DA
Golin
Carol E
CE
Tien
Hsiao-Chuan
HC
Stewart
Paul
P
Kaplan
Andrew H
AH
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009657:North Carolina; D010351:Patient Discharge; D011329:Prisoners / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D019562:Viral Load
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