Drug-resistant HIV noted in prison study

Monday, September 25th 2000, 12:00 am
By: News On 6

Texas research may represent a first

By Laura Beil / The Dallas Morning News
TORONTO – Texas inmates infected with the AIDS virus often carry a form of virus that is able to defy treatment, researchers reported last week.

The findings are part of the first study to examine the presence of drug-resistant human immunodeficiency virus, or HIV, among prisoners. Resistant virus can conquer the medicines that try to suppress it.

During the research, the scientists also identified an inmate who became infected with drug-resistant HIV while behind bars, raising the possibility that the resistant AIDS virus circulates within Texas prisons.

Resistance to treatment is a concern among all AIDS patients, but no one had ever examined the problem among prison inmates, said Dr. William O'Brien of the University of Texas Medical Branch at Galveston. Prisoners have higher rates of HIV infection than the general population.

Drug-resistant virus poses a problem not only for the inmates themselves, but for the people who may catch it from them, and those who will be prescribing medicine for the inmates when they return home.

"People get released from prison, and they go into the community," Dr. O'Brien said, carrying resistant infection with them.

Dr. O'Brien and his colleagues are testing blood samples taken from inmates housed at Texas Department of Criminal Justice prisons in 1998, and comparing them with samples taken from patients at the medical school's clinics the same year.

While he will test 718 samples in all, he discussed an early analysis of almost 500 last week in Toronto during the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy, a meeting on infectious diseases hosted by the American Society for Microbiology.

The inmates were infected with virus that was generally more resistant than the virus among clinic patients, Dr. O'Brien said. For example, tests suggested that about 48 percent of HIV-positive inmates had some resistance to the drug 3TC, compared with about 35 percent of the university patients. But resistance to another drug, AZT, was lower among inmates. Dr. O'Brien tested resistance to several drugs by looking at the virus's genetic profile.

Prisoners have higher rates of HIV infection because many use drugs or engage in risky sexual behavior before they are arrested. About 3 to 4 percent of all Texas inmates are known to be HIV positive, although the actual numbers are believed to be higher, Dr. O'Brien said. And infection rates are higher among imprisoned women than men.

Resistance develops when patients don't take their pills as prescribed. When HIV is only partially controlled, the virus that is least susceptible to the drug is able to thrive and become dominant. From the time they are booked into jail, inmates often have medicine taken away from them or supplied irregularly as they are transferred throughout the justice system, said Dr. John Miles, an AIDS expert at the U.S. Centers for Disease Control and Prevention in Atlanta. This opens the door to drug resistance.

"It's an issue that correctional administrators are more cognizant of," said Dr. Miles, who studies HIV issues among inmates.

Prisoners may also not take their medicine as often as they need to out of fear that – should they be seen taking a lot of pills – they would be stigmatized for having HIV. "It's a small community, and secrets are hard to keep," Dr. Miles said.

As the inmate population rises, so will the issue of drug resistance, he predicted. He said administrators in many parts of the country are working on ways to encourage inmates to take their medicine correctly.

During the study, Dr. O'Brien identified what he believes is the first known case of drug-resistant HIV to be transmitted in prison. The man had several negative HIV tests before having a positive test in February 1997. Less than a year later, doctors found nine genetic mutations that suggested the infection was resistant to some drugs. The man had not yet taken any medicine for his condition.

No one knows how often prisoners contract HIV, said Dr. Richard Pollard, a Galveston researcher also involved in the study. But the discovery points to the need for better AIDS education among inmates, and perhaps other measures, such as issuing condoms and sterile needles to inmates, the researchers said. "I'm convinced there are additional transmissions in the prison setting."