HIV successfully treated in prison and jail

Prisoners with HIV fare well with treatment during incarceration, a Yale study has found. The authors write that, with the lack of accessible community resources, prison can be an “opportunity of last resort” for continuous treatment that can greatly reduce the risk of HIV transmission to others after an inmate’s release. The study appears in JAMA Internal Medicine.

One-sixth of the 1.2 million people living with HIV in the United States cycle through the correctional system each year. By state law, prisoners with HIV must have access to life-saving HIV treatment during incarceration, but the effectiveness of treating HIV during incarceration had not been studied in the last decade.  HIV treatment outcomes had never before been reported for jail detainees, who are often unsentenced and spend a shorter amount of time behind bars.

The Yale researchers studied 882 prisoners and jail detainees with HIV in Connecticut’s correctional system between 2005 and 2012 and described HIV treatment outcomes throughout incarceration. They included people with HIV incarcerated for 90 days or more who were prescribed antiretroviral therapy (ART).

Viral suppression, the major outcome that is associated with individual health improvements and reduced ability to transmit HIV to others, occurred only for one-third of prisoners with HIV entering correctional facilities, representing the lack of care received in our communities.  By the time of release, however, the majority — 70% — achieved viral suppression. Moreover, the authors note, some individuals were more likely to achieve viral suppression before release, specifically women and those with less severe psychiatric issues, regardless of which type of ART regimen they were prescribed or how long they were incarcerated.

The study unveils how inadequate community-based HIV treatment is, and how the highly structured prison environment — often devoid of active drug use or untreated mental illness —helps optimize HIV treatment when combined with simple, well-tolerated and accessible ART regimens, note the researchers.

“This study confirms that HIV can be successfully managed during incarceration when appropriate resources are provided and people can receive adequate treatment for mental illness,” said first author Dr. Jaimie P. Meyer, instructor of infectious diseases at Yale School of Medicine.

Still, the authors assert, from ethical, practical, and economic standpoints, incarceration cannot and should not be the solution for managing HIV in this country. Instead, they say, there is an urgent need for community-based resources that provide comprehensive and stable living situations and identify and treat substance use disorders and mental illness, thereby empowering people to engage in consistent HIV care and remain in community settings.

Other authors are Javier Cepeda, Dr. Frederick Altice, and Dr. Sandra Springer of Yale School of Public Health and Yale School of Medicine; and Dr. Johnny Wu and Dr. Robert Trestman of the University of Connecticut Correctional Managed Healthcare.

This study was supported by a Bristol Myers-Squibb Virology Fellows Award; and grants from the National Institute on Drug Abuse of the National Institutes of Health (K23 DAO33858, F31 DAO35709, K24 DAO17072, and K02 DAO32322).

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