Griffin M M, Ryan J G, Briscoe V S, Shadle K M
Department of Family Practice and Community Medicine, University of Texas-Houston Medical School, Houston, Texas and Stony Brook, New York 77030, USA.
J Natl Med Assoc. 1996 Oct;88(10):639-44.
Human immunodeficiency virus (HIV) infection is a critical problem among the incarcerated population, with rates as high as 17% being reported for prison systems in New York. The literature suggests that stressful living conditions and inherent defects in the immune system associated with HIV infection make prison populations more susceptible to a disproportionate decrease in their CD4 counts. To determine the effects of incarceration on HIV-infected individuals, the charts of 800 inmates were reviewed. Baseline (draw 1), 2- to 5-month (draw 2), and 6- to 12-month (draw 3) CD4 cell counts were obtained. Mean cell counts were calculated, and paired t-tests were used to identify differences. The group receiving antiretrovirals throughout showed no difference in mean CD4 cell count between draws 1 and 2 or between draws 1 and 3. The group not receiving HIV medications did not show a significant difference in CD4 cell counts between draws 1 and 2, but did show a significant difference between draws 1 and 3. For this group, the rate of decline in CD4 cells was greater than among an outpatient setting. The subsample of subjects initiating therapy prior to the second blood draw showed a significant increase in mean CD4 cell counts at draw 1 versus draw 2, but did not show a significant change when comparing draw 1 to draw 3. When examining subjects based on their antiviral status, the mean CD4 cell count at each of the draws was statistically associated with subjects' antiviral status. We conclude that incarceration causes a more rapid decrease in CD4 cells compared with an outpatient population, causing clinical significance on the normal course of HIV disease.
人类免疫缺陷病毒（HIV）感染在被监禁人群中是一个关键问题，纽约监狱系统报告的感染率高达17%。文献表明，与HIV感染相关的压力性生活条件和免疫系统的固有缺陷使监狱人群更容易出现CD4细胞计数不成比例的下降。为了确定监禁对HIV感染者的影响，研究人员查阅了800名囚犯的病历。获取了基线（第一次抽血）、2至5个月（第二次抽血）和6至12个月（第三次抽血）时的CD4细胞计数。计算平均细胞计数，并使用配对t检验来确定差异。在整个过程中接受抗逆转录病毒药物治疗的组在第一次和第二次抽血之间或第一次和第三次抽血之间的平均CD4细胞计数没有差异。未接受HIV药物治疗的组在第一次和第二次抽血之间的CD4细胞计数没有显著差异，但在第一次和第三次抽血之间确实显示出显著差异。对于该组，CD4细胞的下降率高于门诊患者。在第二次抽血之前开始治疗的受试者子样本在第一次抽血时的平均CD4细胞计数与第二次抽血时相比有显著增加，但在比较第一次和第三次抽血时没有显示出显著变化。根据抗病毒状态对受试者进行检查时，每次抽血时的平均CD4细胞计数与受试者的抗病毒状态在统计学上相关。我们得出结论，与门诊人群相比，监禁会导致CD4细胞更快下降，这对HIV疾病的正常病程具有临床意义。
