Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Clin Infect Dis. 2011 Oct;53(7):725-31. doi: 10.1093/cid/cir491.
Incarceration may lead to interruptions in antiretroviral therapy (ART) for persons receiving treatment for human immunodeficiency virus (HIV) infection. We assessed whether incarceration and subsequent release were associated with virologic failure for injection drug users (IDUs) who were previously successfully treated with ART.
ALIVE is a prospective, community-based cohort study of IDUs in Baltimore, Maryland. IDUs receiving ART during 1998-2009 who successfully achieved an HIV RNA level below the limit of detection (<400 copies/mL) were followed up for development of virologic failure at the subsequent semiannual study visit. Logistic regression with generalized estimating equations was used to assess whether incarceration was independently associated with virologic failure.
Of 437 HIV-infected IDUs who achieved undetectable HIV RNA for at least one study visit, 69% were male, 95% were African-American, and 40% reported at least one incarceration during follow-up. Virologic failure occurred at 26.3% of visits after a median of 6 months since achieving undetectable HIV RNA. In multivariate analysis accounting for demographic characteristics, drug use, and HIV disease stage, brief incarceration was strongly associated with virologic failure (adjusted odds ratio, 7.7; 95% confidence interval, 3.0-19.7), although incarceration lasting >30 days was not (odds ratio, 1.4; 95% confidence interval, .8-2.6).
Among IDUs achieving viral suppression while receiving ART, virologic failure occurred with high frequency and was strongly associated with brief incarceration. Efforts should be made to ensure continuity of care both during and after incarceration to improve treatment outcomes and prevent viral resistance in this vulnerable population.
监禁可能会导致正在接受人类免疫缺陷病毒 (HIV) 感染治疗的人中断抗逆转录病毒治疗 (ART)。我们评估了先前成功接受 ART 治疗的注射吸毒者 (IDU) 入狱及其随后获释是否与病毒学失败相关。
ALIVE 是马里兰州巴尔的摩市的一项前瞻性、基于社区的 IDU 队列研究。1998 年至 2009 年期间正在接受 ART 治疗且成功实现 HIV RNA 水平低于检测下限 (<400 拷贝/mL) 的 IDU 会在后续的半年一次的研究访问中随访病毒学失败的发生情况。使用广义估计方程的 logistic 回归来评估监禁是否与病毒学失败独立相关。
在至少一次研究访问中达到不可检测 HIV RNA 的 437 名 HIV 感染 IDU 中，69%为男性，95%为非裔美国人，40%在随访期间至少报告过一次监禁。在中位数为达到不可检测 HIV RNA 后 6 个月的时间里，26.3%的访问中出现病毒学失败。在考虑人口统计学特征、药物使用和 HIV 疾病阶段的多变量分析中，短暂监禁与病毒学失败密切相关（调整后的优势比，7.7；95%置信区间，3.0-19.7），尽管监禁时间 >30 天并无关联（优势比，1.4；95%置信区间，.8-2.6）。
在接受 ART 治疗时达到病毒抑制的 IDU 中，病毒学失败的发生率很高，与短暂监禁密切相关。应努力确保在监禁期间和之后都能获得医疗服务，以改善这一脆弱人群的治疗结局并防止病毒耐药性的产生。
