The Impact of Antiretroviral Therapy in a Cohort of HIV Infected Patients Going in and out of the San Francisco County Jail

Abstract

BackgroundJails are an important venue of HIV care and a place for identification, treatment and referral for care. HIV infected inmates in the San Francisco County jail are offered antiretroviral treatment (ART), which many take only while in jail. We evaluated the effect of ART administration in a cohort of jail inmates going in and out of jail over a nine year period.Methodology/Principal FindingsIn this retrospective study, we examined inmates with HIV going in and out of jail. Inmates were categorized by patterns of ART use: continuous ART - ART both in and out of jail, intermittent ART - ART only in jail; never on ART - eligible by national guidelines, but refused ART. CD4 and HIV viral load (VL) were compared over time in these groups. Over a 9 year period, 512 inmates were studied: 388 (76%) on intermittent ART, 79 (15%) on continuous ART and 45(9%) never-on ART. In a linear mixed model analysis, inmates on intermittent ART were 1.43; 95%CI (1.03, 1.99) times and those never on ART were 2.89; 95%CI (1.71, 4.87) times more likely to have higher VL than inmates on continuous ART. Furthermore, Inmates on intermittent ART and never-on ART lost 1.60; 95%CI (1.06, 2.13) and 1.97; 95%CI (0.96, 3.00) more CD4 cells per month, respectively, compared to continuously treated inmates. The continuous ART inmates gained 0.67CD4 cells/month.Conclusions/SignificanceContinuous ART therapy in jail inmate's benefits CD4 cell counts and control of VL especially compared to those who never took ART. Although jail inmates on intermittent ART were more likely to lose CD4 cells and experience higher VL over time than those on continuous ART, CD4 cell loss was slower in these inmates as compared to inmates never on ART. Further studies are needed to evaluate whether or not intermittent ART provides some benefit in outcome if continuous ART is not possible or likely.

HIV in people reincarcerated in Connecticut prisons and jails: an observational cohort study

“…Its disruption of social networks independently increases risk of HIV transmission, 8 and, for people living with HIV who are prescribed antiretroviral therapy (ART), reincarceration is associated with interruptions in medication adherence and persistence (duration of time from inititation to discontinuation of therapy). 9–12 Although we reported that 70% of inmates with HIV in Connecticut achieved viral suppression during incarceration, 13 we expected on the basis of historical data in this setting 14 and elsewhere 15–18 that viral suppression would not persist after release despite simpler, more potent, and better tolerated ART regimens.…”

Predictors of linkage to HIV care and viral suppression after release from jails and prisons: a retrospective cohort study

“…Criminal justice (CJ) settings are highly structured and can be positioned to diagnose, engage, and treat PLH with antiretroviral therapy (ART), which reduces within-prison morbidity and mortality (4, 5). Short-term detentions within and release from jails, however, are destabilizing and can undermine HIV treatment outcomes (6–8). Recidivism is often influenced by untreated SUDs and psychiatric disorders and can also negatively impact engagement in HIV care, resulting in suboptimal viral suppression (5–7, 9).…”

Correlates of Retention in HIV Care After Release from Jail: Results from a Multi-site Study

“…Previous research confirms that the benefits afforded by ART within prison are rarely sustained after release (9–13). These issues have not yet been fully explored among released jail detainees, but available data suggest that as few as 14% of jail recidivists receive continuous ART (14), a number that is similar to those reported for released HIV-infected prisoners.…”