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

• Published in: BMC infectious diseases Vol. 15; no. 1; p. 562
• Main Authors: Monarca, R., Madeddu, G., Ranieri, R., Carbonara, S., Leo, G., Sardo, M., Choroma, F., Casari, S., Marri, D., Muredda, A. A., Nava, F. A., Babudieri, S.
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.12.2015; BioMed Central
• Subjects: Adult; Aged; AIDS treatment; Anti-HIV Agents - therapeutic use; Antiviral agents; CD4 Lymphocyte Count; Cross-Sectional Studies; Drug therapy; Female; Health aspects; Highly active antiretroviral therapy; HIV (Viruses); HIV - genetics; HIV infection; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV testing; Humans; Infection; Infectious diseases; Italy - epidemiology; Male; Mass Screening; Medical research; Medication Adherence; Medicine, Experimental; Middle Aged; Prevalence; Prevalence studies (Epidemiology); Prisoners - statistics & numerical data; Prisons; RNA, Viral - analysis; Surveys; Surveys and Questionnaires; Italy
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-015-1301-5

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. We piloted a multi-centre cross-sectional study investigating the prevalence of HIV infection and assessing HIV-related medical activities in Italian correctional institutions. 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/mm(3) 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 %). 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.