[Factors related to refuse antiretroviral therapy in prison]

HIV treatment and care among Italian inmates: a one-month point survey

Background

HIV infection, with an estimated prevalence be between 2 and 50 times those of the general adult population is a major health challenge for prison authorities worldwide. Since no nationwide surveillance system is present in Italy, data on HIV prevalence and treatment in prisons are limited to only a few and small observational studies. We aimed to estimate HIV prevalence and obtain an overview on diagnostic and therapeutic activities concerning HIV infection in the Italian penitentiary system.

Methods

We piloted a multi-centre cross-sectional study investigating the prevalence of HIV infection and assessing HIV-related medical activities in Italian correctional institutions.

Results

A total of 15,675 prisoners from 25 institutions, accounting for approximately one-fourth of the prison inmates in Italy, were included in the study, of whom, 97.7 % were males, 37.1 % foreigners and 27 % had a history of intravenous drug addiction. HIV-tests were available in 42.3 % of the total population, with a known HIV Infection proportion of 5.1 %. In the month prior to the study, 604 of the 1,764 subjects who entered prison were tested for HIV, with a HIV-positive prevalence of 3.3 %. Among the 338 HIV-positive prisoners, 81.4 % were under antiretroviral treatment and 73.5 % showed undetectable HIV-RNA. In 23/338 (6.8 %) a coinfection with HBV and in 189/338 (55.9 %) with HCV was also present. Among the 67 (19.8 %) inmates with HIV who did not receive HIV treatment, 13 (19.5 %) had T-CD4+ count <350 cells/mm³ and 9 (69.2 %) of these had refused the treatment. The majority of the inmates with HIV-infection were on a PI-based (62.5 %) or on NNRTIs-based (24.4 %) regimen. Only a minority of patients received once daily regimens (17.2 %).

Conclusions

Although clinical and therapeutic management of HIV infection remains difficult in Italian prisons, diagnostics, treatment and care were offered to the majority of HIV-infected inmates. Specific programs should be directed towards the prison population and strict cooperation between prison and health institutions is needed to increase HIV treatment.

[An analysis of adherence to the "Recommendations for the treatment of human immunodeficiency virus-infected adults" in a penitentiary in Barcelona]

AIM

To analyze the adherence to the "Guidelines for the treatment of HIV-infected adults" among HIV-infected prison inmates.

METHODS

A cross-sectional study was conducted in 2010 in the Quatre Camins Prison (Barcelona, Spain). Epidemiological, clinical and therapeutic variables were collected. We verified whether antiretroviral therapy (ART) met the Guidelines and analyzed the variables associated with compliance using bivariate and multivariate analysis.

RESULTS

There were a total of 202 HIV infected prison inmates, 83.2% of whom were on ART. An undetectable viral load (VL) was observed in 80.4% of treated patients. The large majority (86.1%) met the guidelines, and 42.9% of non-compliance to guidelines was because the patients refused ART. More undetectable VL (P=.001; ORA: 4,30, 95%CI: 1,85 to 10.0) was found in those patients following the guidelines.

CONCLUSION

Compliance with the guidelines is high, and is significantly associated with undetectable VL. We suggest evaluating the quality of prescriptions periodically, and to correct them if needed.