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High mortality among male HIV-infected patients after prison release: ART is not enough after incarceration with HIV.

High mortality among male HIV-infected patients after prison release: ART is not enough after incarceration with HIV.
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Huber F, Merceron A, Madec Y, Gadio G, About V, Pastre A, Coupez I, Adenis A, Adriouch L, Nacher M,


Huber F, Merceron A, Madec Y, Gadio G, About V, Pastre A, Coupez I, Adenis A, Adriouch L, Nacher M, (click to view)

Huber F, Merceron A, Madec Y, Gadio G, About V, Pastre A, Coupez I, Adenis A, Adriouch L, Nacher M,

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PloS one 2017 04 2812(4) e0175740 doi 10.1371/journal.pone.0175740

Abstract
CONTEXT
French Guiana is a South American French territory, where HIV prevalence consistently exceeds 1% in the adult population. In the only correctional facility, HIV prevalence fluctuates at around 4%.

AIMS
After describing the population of HIV-positive inmates, we aimed to evaluate mortality after release from the correctional facility, and to identify its predictive factors.

RATIONALE
Outside North American settings, data on treatment outcome and vital status of HIV-positive former inmates are scarce. There were no data in French Guiana. Filling this gap represents a basis for potential improvements.

METHODS
All HIV-infected adults released from an incarceration of 30 days or more, between 2007 and 2013, were enrolled in a retrospective cohort study. Mortality was described over time, one to seven years following release, using Kaplan-Meier estimates. Factors associated with mortality were identified through a non-parametric survival regression model.

RESULTS
147 former inmates were included. The male to female ratio was 4.4. The median age was 37.3 years. The majority were migrants, 25.8% were homeless, 70.1% suffered from substance abuse, with 34.0% of crack-cocaine users. On admission, 78.1% had an early HIV-stage infection (CDC-stage A), with a median CD4 count of 397.5/mm3, 34.0% had one comorbidity, mainly hypertension. Upon release, 50.3% were on ART. Reasons for not being treated were not fulfilling the criteria for 74.6%, and refusing for 15.1%. Before release, 84.5% of the patients on ART had a viral load≤200cp/ml. After release, 8.2% of the cohort had died, with a crude incidence of 33.8/1000 person-years. All recorded deaths were males, with an incidence of 42.2/1000 person-years. Comparing with the age-specific mortality rates for males in French Guiana, the standardized mortality ratio was 14.8. In multivariate analysis, factors associated with death were age and CD4 count before release.

CONCLUSION
Despite access to ART while incarcerated, with good virological outcome, the post-release mortality was very high for males, almost 15 times what is observed in the general male population living in French Guiana, after age standardization. Access to ART in correctional facilities may be a necessary, but not sufficient condition to protect male inmates from death after release.

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