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

BACKGROUND: 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.
METHODS: We piloted a multi-centre cross-sectional study investigating the
prevalence of HIV infection and assessing HIV-related medical activities in
Italian correctional institutions.
RESULTS: 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 %).
CONCLUSIONS: 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.