HIV/AIDS is up to five times more prevalent in American prisons than in the general population. Adherence to treatment programs can be strictly monitored in prison. However, once prisoners are released, medical monitoring becomes problematic. A new study by Dr. Nitika Pant Pai – an Assistant professor of Medicine and a medical scientist at the Research Institute of the MUHC – suggests the majority (76%) of inmates take their antiretroviral treatment (ART) intermittently once they leave prison, representing a higher risk to the general population.
"Over a period of 9 years, we studied 512 HIV positive repeat offender inmates from the San Francisco County jail system," says Dr. Pant Pai. "Our results show that only 15% continuously took their ART between incarcerations or after their release." According to the study, published in the journal PLoS ONE, these figures highlight a lack of effectiveness on the part of medical monitoring services for these people outside prison.
"Taking ART intermittently is a problem because it depletes the CD4 count - the immunizing cells that fight infection – and increases the probability of developing resistance to the virus," says Dr. Pant Pai. "The risk for rapid disease progression becomes higher and presents a risk for public health transmission of HIV to their partners." According to the study those on intermittent therapy were 1.5 times more likely to have higher virus load than those on continuous therapy; those who never received therapy were 3 times more likely to have a higher VL.
"The optimal solution for treating patients and controlling the HIV/Aids epidemic in the USA is to ensure continuous therapy," explains Dr. Milton Estes, medical director of Forensic AIDS Project, San Francisco. "To achieve this we must work on various aspects of the prisoner's lives, such as marginalization, psychiatric problems and drug use, both before and after their departure from prison." According to Dr. Jacqueline Tulsky, senior author of the study, "This research highlights the need to examine ART policies inside and outside correctional settings with a view to establishing effective life long management of HIV in prisoners."
"This research is the first observational study in American prisons to evaluate the impact of antiretroviral treatment (ART) over a nine year period. It demonstrates the need for effective community transition and prison release programs to optimize ART given in jails," explains Dr. Pant Pai.
The article was co-authored by Dr. Nitika Pant Pai, Infection and Immunity Axis at the RI-MUHC, Dr. Milton Estes, Forensic AIDS Project, Department of Public Health, San Francisco, Dr. Erica E.M. Moodie, Department of Epidemiology and Biostatistics, McGill University, Dr. Arthur L Reingold, Epidemiology Division, University of California, Berkeley, USA, Dr. Jacqueline P Tulsky, University of California, San Francisco, Positive Health Program, San Francisco General Hospital, USA.
Funding was provided by a grant from the National Institutes of Health.
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