Issues related to HIV/AIDS in prisons have traditionally received little attention at the International AIDS Conference. Yet, it is a well-known fact that HIV prevalence within prison populations tends to be much higher than in the general population both in the United States and worldwide. This year's conference, "AIDS 2004," held in Bangkok, Thailand, (July 11-16) may, however, represent a turning point.
The crowded conditions that exist in many of the world's jails and prisons create an ideal environment for the transmission of contagious diseases. Restrictions on the availability of clean laundry, soap, water, condoms and needle exchange increase the probability that infectious diseases will be transmitted from one person to another. Furthermore, the transient status of inmates who are frequently moved from one location to another can complicate the diagnosis of infection, recognition of an outbreak, performance of a contact investigation, interruption of ongoing transmission,and eradication of disease.
The Hepatitis C virus (HCV) is a major public health problem and the most common cause of death from liver disease in the United States. According to population-based studies, HCV accounts for more than 40% of chronic liver disease in the U.S., and causes about 10,000 deaths per year. Although the proportion of these deaths that occur in correctional facilities is believed by many to be as high as 30% and rising, the exact numbers of deaths due to HCV that occur in the U.S. correctional system is unknown.
Pertinent Topics on HIV Infection Among Women: Prevention, Lipodystrophy, and Drug-drug Interactions
Mother-to-child transmission (MTCT) may be prevented by treating the mother and/or her baby with antiretroviral therapy (ART). Studies have shown a 66% reduction or greater in vertical transmission with different antiretroviral treatment strategies, including both mono- and combination therapy. The first of these studies, initially reported in 1994, showed that the HIV-1 transmission rate for infants who received placebo was 22.6%, compared with 7.6% for those who received zidovudine (AZT).
Diseases of the gastrointestinal tract are common among those who are HIV-infected. Sometimes the first clue that a previously undiagnosed inmate/patient is HIV-infected is the presence of an HIV-associated gastrointestinal condition. These conditions can lead to significant morbidity including pain, difficulty swallowing, diarrhea, and weight loss. Early diagnosis and treatment can substantially improve the lives of those who are afflicted by these conditions.
Update From the 11th Conference On Retroviruses and Opportunistic Infections (CROI)
United Nations Special Envoy on HIV/AIDS in Africa Stephen H. Lewis discussed the current state of the HIV epidemic. Worldwide it is estimated that 10 million women aged 15-24 years old are HIV-infected, and six million persons need antiretroviral treatment (ART) based upon a CD4 count of less than 200/mm3. An estimated four million Africans have a CD4 count of less than 200/mm3; less than 3% are receiving ART.
In the Spring of 2003, the American Thoracic Society (ATS), Infectious Diseases Society of America, and Centers for Disease Control and Prevention (CDC) issued updated guidelines for the treatment of tuberculosis (TB). These guidelines are substantially longer and significantly more comprehensive than the prior ATS/CDC guidelines published in 1994. The document is a guideline for the treatment of TB disease only and does not include management of latent TB infection (LTBI).
The effective medical management of any chronic illness depends upon the ability to record and recall data. In addition, reimbursement and risk management often hinge upon the maintenance of an accurate, complete medical record. As treatments become more complex, it has become increasingly difficult to accomplish these tasks solely through the use of a paper record. In response to these growing demands, a wide variety of electronic medical record (EMR) systems have been created.
Clinically Significant Drug Interactions Associated with Highly Active Antiretroviral Therapy
One of the most challenging issues facing providers treating patients with human immunodeficiency virus - 1 (HIV) infection is the complex problem of drug interactions associated with highly active antiretroviral therapy (HAART). Guidelines for the initial treatment of HIV infection recommend the use of at least three antiretroviral medications, each of which is associated with significant drug interactions.
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