Better outcomes for people exposed to HIV in prisons

A world-first study published in the current edition of the Medical Journal of Australia has found that treating people exposed to human immunodeficiency virus (HIV) in prison with anti-HIV drugs after exposure (post-exposure prophylaxis) can help stop them becoming infected. However, preventing infection was complicated by difficulties in identifying those at risk and follow-up.

The study also examined whether infection with HIV, hepatitis B virus (HBV) or hepatitis C virus (HCV) occurred after needle and syringe-sharing in Australian prisons.

"Transmission of these diseases is related to the increased prevalence of these viruses in the prison population, high-risk injecting and sexual behaviour and the limited availability of prevention methods," said Dr Andrew Grulich, Associate Professor at the National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales, Sydney.

The study was undertaken by Dr Grulich and colleagues at the University of New South Wales, NSW Department of Health, NSW Corrections Health Service, Prince of Wales Hospital and Westmead Hospital, Sydney.

"The study involved follow-up over 14 months of 104 people who shared needles and syringes with two prisoners infected with HIV, HBV and HCV in two different prisons," Dr Grulich said.

"Four inmates developed antibodies to HCV within 14 months of the potential exposure, indicating they were infected, but no inmates developed antibodies to HBV or HIV.

"Thirty four of the 46 inmates who were offered HIV post-exposure prophylaxis (PEP) elected to receive it. Only eight of the 34 completed the full PEP course. PEP was commonly ceased when inmates were transferred to another prison or released.

Most of those who were susceptible to HBV infection received HBV vaccination or immunoglobulin.

"The study concluded that HCV transmission in the prison setting is related to high-risk needle and syringe-sharing. It also found that administering HIV PEP in the prison setting is complicated by challenging risk assessment and follow-up.

"Community-standard needle and syringe exchange programs would help prevent the spread of hepatitis C in prisons.

"Specific guidelines for the use of PEP in prisons should be developed by correctional health services to improve the administration of PEP in the prison setting," Dr Grulich said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

 CONTACT: Dr Andrew Grulich, 0414 385317

Judith Tokley, AMA, 0408 824 306