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Virologic response to HAART among incarcerated HIV+ individuals
Presented by David Wohl, United States.
D. Wohl1, A. Fleg2, S. Napravnik1, M. Williams1, R. Boyce2, N. Kiziah3, C.-A. Harrell1, B. White1
1The University of North Carolina, Division of Infectious Diseases, Chapel Hill, United States, 2The University of North Carolina, School of Medicine, Chapel Hill, United States, 3The North Carolina Department of Corrections, Raleigh, United States
Background: It is estimated that a quarter of HIV+ persons in the US enter a correctional facility each year; however, there are limited data on the virologic response to HAART in correctional settings.
Methods: Retrospective cohort study of all HIV-infected prison inmates with a documented start of initial HAART while incarcerated from 2000-2006 in NC - a state where HIV care is provided by university-based HIV specialists. All FDA-approved ART are included on the prison formulary. Per prison policy, only PI-based regimens are administered DOT.
Results: A total of 198 inmates naive to HIV therapy were started on HAART during the study period: 81.0% male, 79.5% AA, median age=38.2 years (IQR 30.6, 43.0). Prior to ART initiation, the median CD4 and log10 HIV RNA levels were 210 (IQR, 100, 321) and 4.96 (IQR, 4.39, 5.52), respectively. The median year of ART initiation was 2003 (IQR, 2002, 2004), with most patients receiving an NNRTI-based regimen (78.4%, primarily efavirenz), followed by an NRTI-only (10.2%, primarily trizivir), PI (9.7%, primarily nelfinavir), and ritonavir-boosted-PI regimen (1.7%, primarily lopinavir/ritonavir). A VL <400 c/mL was achieved by 72.2% at any time within 18 months of HAART initiation. Of the 143 patients with at least 3 months of data, 84.6% had a VL <400 c/mL within 18 months of HAART. A VL <400 c/mL was observed in 59.7% (86/144) at the first VL determination after 3 months of HAART, 64.8% (68/105) at first VL after 6 months and 71.2% (52/73) at first VL after 12 months. Treatment discontinuation rates were low.
Conclusions: Virologic response rates among HIV-infected men and women incarcerated in a US state prison were high and comparable to rates observed in clinical trials of treatment naive subjects and community clinical cohorts. Maintenance of the virologic benefits of HAART post-prison release are critical to continued personal and public health.
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