Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06511, USA.
Am J Drug Alcohol Abuse. 2011 Jan;37(1):12-21. doi: 10.3109/00952990.2010.540280. Epub 2010 Dec 21.
People with both HIV and alcohol use disorders (AUDs) are disproportionately concentrated within the U.S. criminal justice system; approximately one-quarter of all people with HIV cycle through the system each year. HIV-infected prisoners with AUDs face many obstacles as they transition back to the community. Specifically, although they have impressive HIV treatment outcomes during the period of incarceration while they are free from alcohol; upon [corrected] release, however, they face inordinate challenges including relapse to alcohol use resulting in significant morbidity and mortality.
To review the existing literature regarding the relationship of HIV and treatment for AUDs within the criminal justice system in an effort to determine "best practices" that might effectively result in improved treatment of HIV and AUDs for released prisoners.
PubMed, PsychInfo and Medline were queried for articles published in English from 1990 to 2009. Selected references from primary articles were also examined.
Randomized controlled trials affirm the role of pharmacotherapy using naltrexone (NTX) as the therapeutic option conferring the best treatment outcome for AUDs in community settings. Absent from these trials were inclusion of released prisoners or HIV-infected individuals. Relapse to alcohol abuse among HIV-infected prisoners is associated with reduced retention in care, poor adherence to antiretroviral therapy with consequential poor HIV treatment outcomes and higher levels of HIV risk behaviors.
Untreated alcohol dependence, particularly for released HIV-infected prisoners, has negative consequences both for the individual and society and requires a concentrated effort and rethinking of our existing approaches for this vulnerable population.
同时患有艾滋病病毒（HIV）和酒精使用障碍（AUD）的人群在美国刑事司法系统中不成比例地集中；每年约有四分之一的 HIV 感染者会经历这个系统。患有 AUD 的 HIV 感染囚犯在返回社区时面临许多障碍。具体来说，尽管他们在监禁期间没有饮酒时，在 HIV 治疗方面取得了令人印象深刻的结果；然而，一旦获释，他们面临着过度的挑战，包括酗酒复发，导致严重的发病率和死亡率。
回顾关于 HIV 和刑事司法系统中 AUD 治疗之间关系的现有文献，以确定可能有效提高出狱囚犯 HIV 和 AUD 治疗效果的“最佳实践”。
在 1990 年至 2009 年期间，在 PubMed、PsychInfo 和 Medline 上查询发表的英文文章。还检查了主要文章的选定参考文献。
随机对照试验证实了使用纳曲酮（NTX）进行药物治疗的作用，作为在社区环境中治疗 AUD 的最佳选择，为 AUD 提供了最佳的治疗结果。这些试验中没有包括出狱囚犯或 HIV 感染者。HIV 感染囚犯酗酒复发与护理保留率降低、抗逆转录病毒治疗依从性差以及 HIV 治疗结果不佳以及 HIV 风险行为水平升高有关。
未经治疗的酒精依赖，特别是对出狱的 HIV 感染者，对个人和社会都有负面影响，需要集中精力和重新思考我们现有的方法来解决这一弱势群体。
