Prior to the availability of effective antiretroviral therapy (ART), most patients with HIV infection could expect to experience a fairly predictable and inexorable decline in their CD4 count. Once a patient’s CD4 count declines significantly, prophylaxis for opportunistic infections is initiated and continues indefinitely.
Following a virtual renaissance in HIV therapeutics in the mid 1990’s, the later part of the decade witnessed a sputtering of the HIV treatment pipeline. Since 1998 only three new antiretroviral agents have come to market, amprenavir (Agenerase), lopinavir-ritonavir (Kaletra) and tenofovir (Viread).
Why should the correctional HIV provider care about T cells, T cell epitopes, and HLA molecules? Because the use of Strategic Treatment Interruption (STI) and therapeutic vaccines for the treatment of HIV – particularly acute HIV infection – may be on the horizon for our patients.
Recent outbreaks of communicable diseases in correctional settings have underscored the importance of identifying communicable diseases, educating inmates and staff, and treating where appropriate. In June 2001, an outbreak of HBV was reported in a state correctional facility in Georgia.
Hepatitis B Virus (HBV) infection is very common with over 350 million chronically infected people worldwide including 1.25 million in the United States. The incidence of acute HBV infection in the U.S. has declined from 450,000 new infections per year in the 1980s to 80,000 in 1999.
HIV infection among incarcerated women has become a hidden epidemic in the United States. Factors that contribute to this epidemic include an increase of over 500% in the absolute number of women incarcerated in 1999 compared to 1980, and a higher seroprevalence of HIV in incarcerated women compared to US women in general (3.5% vs. 0.1%, See Figure 1).1 Together, these factors have led to a steady increase in incarcerated women with HIV infection, compared to a plateau in the number of HIV positive male offenders over the past five years.
Treatment of Hepatitis C (HCV) is emerging as the most controversial subject in correctional health care. Much of the controversy around HCV testing and treatment in corrections is related to delayed recognition of the important role incarcerated individuals play in the transmission of hepatitis in the communities after they are released.
There is a perilous synergy between HIV and tuberculosis in correctional facilities. Prisoners, who have long been known to have disproportionately high rates of diagnosed TB disease and TB infection, also have more than 5 times the general population's rate of AIDS, and between 4 and 10 times the general population's rate of HIV infection. Crowding, poor ventilation, the high prevalence of HIV among prisoners, and the higher prevalence of TB in the communities from which prisoners are disproportionately drawn can make correctional facilities key sites of amplification for TB transmission.
HIV experts unanimously agreed on three aspects of HIV management during the 8th national Conference on Retroviruses and Opportunistic Infections (8th CROI), held in Chicago during Feb 3-5 of this year. The three points of agreement were: promoting voluntary testing, improving access to care, and the need for new approaches to eradicating latent HIV after initiating treatment with HAART.
Mental health issues are difficult territory for any healthcare provider. The situation becomes exponentially more complex when the patient is incarcerated and HIV is added to the mix. The multifactorial etiology of mental illness makes diagnosis and management of these patients quite challenging. Treatment is further complicated by factors such as potential medication side effects and interactions and mental status changes due to opportunistic infections.
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This information is designed to support, not replace, the relationship that exists between you and your doctor.