Unexpected High Rate of Wild-Type HIV-1 Genotype Among Inmates Failing Antiretroviral Therapy

Abstract

The prevalence of mutated strains in treatment-naïve individuals of the studied cohort is comparable to what is reported in nonimprisoned naïve subjects of our region. The high prevalence of WT genotypes in ART-failing patients makes it likely that they were not taking their treatments, probably to gain legal benefits from their worsening health conditions. Thus, resistance testing can also be considered as an additional tool for assessing adherence to ART for forensic/medicolegal evaluation. However, further and larger studies are necessary to validate it.

Low Prevalence of Antiretroviral Resistance Among HIV Type 1-Positive Prisoners in the Southeast United States

“…Although small, our sample of prisoners with no indication of ARV treatment in prison is similar in size to the naive subjects in other prison studies (Spanish n = 43; Italian n = 16; Massachusetts n = 25). 13,15,16 Furthermore, our overall prevalence estimate for ARV resistance in this group of prisoners is similar to that of the Massachusetts cohort. 13 Centralization of HIV care in the NC DOC, limited to only four ID clinics for the entire state and staffed by a dedicated group of ID trained clinicians, is a study strength as it likely results in similar access to genotype testing for all HIV-positive inmates.…”

“…23 Among prisoners with no indication of ARV treatment experience during incarceration, we detected a higher (13.2%) prevalence of the K103 N mutation in comparison to prevalence estimates among treatment-naive populations from both correctional and noncorrectional settings. 13,15,16,24 However, the relatively high prevalence of K103 mutations in our study as compared to others may simply reflect unmeasured ARV exposure immediately prior to incarceration; the estimate should also be interpreted with caution due to the small sample size. Although small, our sample of prisoners with no indication of ARV treatment in prison is similar in size to the naive subjects in other prison studies (Spanish n = 43; Italian n = 16; Massachusetts n = 25).…”

“…However, the proportion of prisoners with genotypes in our study is similar to that of other published reports. 16 Because resistant testing can be conducted only when viral load is > 500 HIV RNA c/ml, it is possible that our results underestimate the true prevalence of resistance in the NC prison population because prisoners with viral loads between 40 and 500 HIV RNA c/ml may not have been genotyped.…”

“…To date, there have been only five studies examining ARV resistance among prisoners-two in the United States 13,14 and three in Europe. [15][16][17] Of the two studies conducted in the United States, 13 one focused on 67 seroconverters during incarceration and restricted surveillance to only four major mutations. 14 The second study surveyed only 25 ARV treatment-naive prisoners.…”

HIV Drug Resistance and Transmission Networks Among a Justice-Involved Population at the Time of Community Reentry in Washington, D.C.

“… 4–7 However, all these studies focused on incarcerated individuals, similar to such studies performed outside of the United States. 8–11 To our knowledge, there have been no studies that have examined the emergence of drug resistance among persons with HIV recently released from correctional facilities.…”