BACKGROUND: Despite the high
prevalence of
HIV in correctional settings, the duration of therapy and response to various
highly active antiretroviral therapy (
HAART) regimens in this setting is unknown. METHOD: Using a
retrospective cohort study (1997-2002) of HIV-infected prisoners in Connecticut that linked demographic,
pharmacy, and laboratory data, we compared
HIV-1 RNA (VL) and
CD4 lymphocyte responses to four treatment strategies at baseline and at the end of incarceration. RESULTS: Using an analysis of 1,044 incarceration periods or 1,099 subjects for whom 6 months of continuous data were available,
HAART regimens that included a triple
NRTI, two
NRTIs + either a PI or
NNRTI, or a three-class (
NRTI+
NNRTI+PI) strategy demonstrated no difference in virological and
immunological outcomes. The proportion of subjects who were initiated with
NRTI,
NNRTI, PI, or three-class regimens were 14%, 32%, 46%, and 8%, respectively. For all study groups, the
mean change from baseline in
CD4 and VL was +74 cells/muL and -0.93 log(10) copies/mL (p < .0001), respectively. Overall, 59% of subjects had an
HIV-1 RNA level below the level of detection (<400 copies/mL) by the end of their incarceration. Using
Kaplan-Meier curves to examine the time to change in the initial
HAART strategy over the incarceration period, the three-class strategy was significantly more likely to be changed earlier than all others (p < .05). CONCLUSION: Although the three-class strategy was less durable, initiating
HAART with any strategy resulted in similar and
impressive virological and
immunological outcomes by the end of incarceration, further supporting prison as an important site for the initiation and provision of effective
antiretroviral therapy.
