title: HIV treatment and care among Italian inmates: a one-month point survey.
abstract: BACKGROUND
  HIV infection, with an estimated prevalence be between 2 and 50 times those of the general adult population is a major health challenge for prison authorities worldwide. Since no nationwide surveillance system is present in Italy, data on HIV prevalence and treatment in prisons are limited to only a few and small observational studies. We aimed to estimate HIV prevalence and obtain an overview on diagnostic and therapeutic activities concerning HIV infection in the Italian penitentiary system.
  
  
  METHODS
  We piloted a multi-centre cross-sectional study investigating the prevalence of HIV infection and assessing HIV-related medical activities in Italian correctional institutions.
  
  
  RESULTS
  A total of 15,675 prisoners from 25 institutions, accounting for approximately one-fourth of the prison inmates in Italy, were included in the study, of whom, 97.7 % were males, 37.1 % foreigners and 27 % had a history of intravenous drug addiction. HIV-tests were available in 42.3 % of the total population, with a known HIV Infection proportion of 5.1 %. In the month prior to the study, 604 of the 1,764 subjects who entered prison were tested for HIV, with a HIV-positive prevalence of 3.3 %. Among the 338 HIV-positive prisoners, 81.4 % were under antiretroviral treatment and 73.5 % showed undetectable HIV-RNA. In 23/338 (6.8 %) a coinfection with HBV and in 189/338 (55.9 %) with HCV was also present. Among the 67 (19.8 %) inmates with HIV who did not receive HIV treatment, 13 (19.5 %) had T-CD4+ count <350 cells/mm(3) and 9 (69.2 %) of these had refused the treatment. The majority of the inmates with HIV-infection were on a PI-based (62.5 %) or on NNRTIs-based (24.4 %) regimen. Only a minority of patients received once daily regimens (17.2 %).
  
  
  CONCLUSIONS
  Although clinical and therapeutic management of HIV infection remains difficult in Italian prisons, diagnostics, treatment and care were offered to the majority of HIV-infected inmates. Specific programs should be directed towards the prison population and strict cooperation between prison and health institutions is needed to increase HIV treatment.
authors.affiliation: Infectious Diseases Unit, Belcolle Hospital, Viterbo, Italy. roberto.monarca@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Monarca
authors.affiliation: Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 35b, 07100, Sassari, Italy. giordano@uniss.it.
authors.forename: G
authors.initials: G
authors.lastname: Madeddu
authors.affiliation: Infectious Diseases Unit, A.O. San Paolo, Milan, Italy. roberto.ranieri@ao-sanpaolo.it.
authors.forename: R
authors.initials: R
authors.lastname: Ranieri
authors.affiliation: Institute of Infectious Diseases, University of Bari, Bari, Italy. s_carbonara@yahoo.it.
authors.forename: S
authors.initials: S
authors.lastname: Carbonara
authors.affiliation: Infectious Diseases Unit, Amedeo di Savoia Hospital, Torino, Italy. dhc@libero.it.
authors.forename: G
authors.initials: G
authors.lastname: Leo
authors.affiliation: Cotugno Hospital, Infectious Diseases Unit, Naples, Italy. massimosardo@libero.it.
authors.forename: M
authors.initials: M
authors.lastname: Sardo
authors.affiliation: Infectious Diseases Unit, AUSL, Parma, Italy. fchoroma@ausl.pr.it.
authors.forename: F
authors.initials: F
authors.lastname: Choroma
authors.affiliation: Institute of Infectious Diseases, University of Brescia, Brescia, Italy. s.casari@infettivibrescia.it.
authors.forename: S
authors.initials: S
authors.lastname: Casari
authors.affiliation: Infectious Diseases Unit, A.O. Santa Maria alle Scotte, Siena, Italy. daniele.marri@libero.it.
authors.forename: D
authors.initials: D
authors.lastname: Marri
authors.affiliation: Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 35b, 07100, Sassari, Italy. albertomuredda@hotmail.it.
authors.forename: A A
authors.initials: AA
authors.lastname: Muredda
authors.affiliation: Penitentiary Medicine, Padova, Italy. felicealfonso.nava@sanita.padova.it.
authors.forename: F A
authors.initials: FA
authors.lastname: Nava
authors.affiliation: Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Sassari, Viale San Pietro 35b, 07100, Sassari, Italy. babuder@uniss.it.
authors.forename: S
authors.initials: S
authors.lastname: Babudieri
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D055118:Medication Adherence; D008875:Middle Aged; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data; D012367:RNA, Viral / Q000032:analysis; D011795:Surveys and Questionnaires
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral