title: [Antiretroviral therapy in inmates: between guidelines and reality of Italian correctional facilities].
abstract: In HIV-positive patients detention often represents a unique opportunity for health care. HIV-positive inmates enjoy the same rights as non-restricted people, as established under national and international legislation, declarations and guidelines. Antiretroviral therapy in restricted men shows some peculiarities such as the voluntary non-taking of drugs to worsen the health status or obtain legal benefits and the high frequency of concomitant psychiatric treatment. On the other hand, patient compliance may be considerably improved by adopting DOT strategy. Aiming to define the choices of first and subsequent lines of therapy with respect to the patient's epidemiological characteristics and other ongoing treatments in two major correctional facilities in Milan (Opera and San Vittore, harbouring about 2500 inmates), we collected punctual data (March 6, 2014) drawn from the single patient forms of therapy. Our results show the same prevalence of HIV infection in both facilities (3%), AIDS and viral hepatitis coinfection cases being more frequent in Opera. Both in Opera and San Vittore we found a high adherence to antiretroviral therapy (high CD4 count average and high percentage of HIV-RNA suppressed). The first and subsequent choice of main lines was TDF+FTC+RTV+ATV. The choice of efavirenz (EFV) as the third drug was often excluded due to its neuropsychiatric implications. The most common cause of drug change was toxicity followed by simplification and then by virological failure. Finally we showed a high frequency of concomitant psychiatric therapy (77% in Opera, 67% in San Vittore), noting the hypothetical interactions with antiretroviral drugs.
authors.affiliation: Casa Circondariale San Vittore; Casa di Reclusione di Opera; U.O. Farmacia A.O. San Paolo; U.O. Malattie Infettive A.O. San Paolo, Milano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ranieri
authors.affiliation: Casa Circondariale San Vittore; Casa di Reclusione di Opera; U.O. Farmacia A.O. San Paolo; U.O. Malattie Infettive A.O. San Paolo, Milano, Italy.
authors.forename: Jvana
authors.initials: J
authors.lastname: Sommella
authors.affiliation: Casa Circondariale San Vittore; Casa di Reclusione di Opera; U.O. Farmacia A.O. San Paolo; U.O. Malattie Infettive A.O. San Paolo, Milano, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: D'Angelo
authors.affiliation: Casa Circondariale San Vittore; Casa di Reclusione di Opera; U.O. Farmacia A.O. San Paolo; U.O. Malattie Infettive A.O. San Paolo, Milano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nigro
authors.affiliation: Casa Circondariale San Vittore; Casa di Reclusione di Opera; U.O. Farmacia A.O. San Paolo; U.O. Malattie Infettive A.O. San Paolo, Milano, Italy.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Poccobelli
authors.affiliation: Casa Circondariale San Vittore; Casa di Reclusione di Opera; U.O. Farmacia A.O. San Paolo; U.O. Malattie Infettive A.O. San Paolo, Milano, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Lari
authors.affiliation: Casa Circondariale San Vittore; Casa di Reclusione di Opera; U.O. Farmacia A.O. San Paolo; U.O. Malattie Infettive A.O. San Paolo, Milano, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Di Benedetto
authors.affiliation: Casa Circondariale San Vittore; Casa di Reclusione di Opera; U.O. Farmacia A.O. San Paolo; U.O. Malattie Infettive A.O. San Paolo, Milano, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: D'Arminio Monforte
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D015897:Comorbidity; D017408:Guidelines as Topic; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons; D019966:Substance-Related Disorders / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects