Study finds major interruptions in antiretroviral therapy after release from prison

The vast majority of HIV-infected Texas prison inmates who receive antiretroviral therapy while incarcerated experience significant interruptions in HIV treatment after their release into the community.

This disturbing finding is the result of a 4-year study of more than 2,000 inmates with HIV infection released from Texas Department of Criminal Justice prisons between January 2004 and December 2007. The study, led by University of Texas Medical Branch at Galveston epidemiologist and associate professor Jacques Baillargeon, will appear in the Feb. 25 issue of the Journal of the American Medical Association.

Using databases maintained by the Texas Department of State Health Services and TDCJ, Baillargeon and his co-investigators found that only 18 percent of inmates filled a prescription for antiretroviral medications within 30 days after release. Moreover, only 30 percent did so within 60 days. "These remarkably high rates of lengthy HIV treatment interruptions are troublesome from a public health perspective," said Baillargeon. "Several studies suggest that many released inmates who discontinue antiretroviral therapy also resume high-risk behaviors such as injection drug use or unsafe sex, and this combination may result not only in poor clinical outcomes for these individuals but also in the creation of drug-resistant HIV reservoirs in the general community."

Dr. David Paar, a co-author and director of the clinical virology division of UTMB Correctional Managed Care, said that this high rate of treatment interruption appears related in large part to multiple barriers faced by newly released inmates in accessing community-based health care. "A solution to this problem will require carefully coordinated efforts between the criminal justice system, public health agencies, and community healthcare systems," Paar noted.