Incarcerated HIV Patients Have Similar Responses to Antiretrovirals as Other Populations: Presented at AIDS 2008

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Title: Incarcerated HIV Patients Have Similar Responses to Antiretrovirals as Other Populations: Presented at AIDS 2008
URL: http://www.pslgroup.com/dg/2278B6.htm
Doctor's Guide
August 8, 2008

By Kate Jongbloed

MEXICO CITY -- August 8, 2008 -- Jail inmates with human immunodeficiency virus (HIV) respond just as well to highly active antiretroviral therapy (HAART) as do infected individuals who are not behind bars, researchers stated here at the 17th International AIDS Conference (AIDS 2008).

In cooperation with the North Carolina Corrections Facility, the treatment of 160 incarcerated patients who initiated antiretroviral therapy between 2000 and 2006 was scrutinised. "The results that we're seeing are very similar to [those in] trials of HIV therapy and also in clinical cohorts of people who are free," said lead author David Wohl, MD, University of North Carolina, Chapel Hill, North Carolina, speaking at an oral presentation here on August 7.

The treatment-naïve subjects (80% male, between 30 and 44 years of age) were introduced to several different types of antiretroviral treatment in prison, including non-nucleoside reverse transcriptase inhibitors; protease inhibitors; protease inhibitors with boosters; and nucleoside reverse transcriptase inhibitors.

About 83% of the HIV-positive inmates' treatment regimes included non-nucleoside reverse transcriptase inhibitors, Dr. Wohl noted. Protease-inhibitor combinations were utilised by about 8% of patients. Triple nucleoside analogue treatment was utilised by 6% of patients. Boosted protease inhibitor regimens were employed by 3% of patients.

The specific medications included in the various treatment options offered to patients in the North Carolina prisons were as follows:

· Efavirenz was used in 91% of the non-nucleoside regimens; nevirapine was used in 9% of these regimens

· Nelfinavir was used in 85% of protease inhibitor-based regimens; ritonavir was used in 2% of these patients

· Lopinavir/ritonavir was used in 100% of boosted-protease inhibitor regimens

Abacavir, lamivudine, and zidovudine were used in 100% of patients treated with a triple nucleoside analogue regimen.

The researchers' recommendations for improving future antiretroviral therapy programs for HIV-positive incarcerated individuals include initiating support programs that bridge the gap between incarceration and freedom.

Treatment discontinuation rates were low while inmates remained in prison, explained Dr. Wohl, but 73% of discontinuations occurred when the prisoners were released from prison. The study indicated that after release, HIV-positive inmates' viral loads increased and CD4-positive cell counts decreased.

"Probably the worst thing that can happen to you if you're on HIV therapy in prison is to get released," commented Dr. Wohl. He added that, upon release, the former prisoners were more likely to participate in risky behaviours, such as unsafe sex.

This presentation was part of a symposium that examined the treatment of so-called "hard-to-treat" populations. Dr. Wohl disagreed with this classification: "I don't think that prisoners are 'hard to treat,'" he concluded.

[Presentation title: Virologic Response to HAART Among Incarcerated HIV+ Individuals. Abstract: THAB0503]

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