DIFFERENTIAL CHARACTERISTICS OF AIDS PATIENTS WITH A HISTORY OF IMPRISONMENT

Background. AIDS is among the leading causes of death in prisons, but there is little information about AIDS patients with a history of impr isonment. Methods. AIDS patients diagnosed in Barcelona between 1988 a nd 1993 were studied. Those with prison histories were compared to tho se without, with respect to epidemiological variables, including survi val analysis. Results. 28.5% of 2336 AIDS patients, 49.4% of intraveno us drug users (IVDU) and only 2.6% of homosexuals who were not IVDU ha d a prison history. Those with prison histories, compared to those wit hout, were younger (median age of 30.6 versus 36.4, P < 0.0001), more often IVDU than homosexuals (87.8% versus 35.8%, OR = 36.9, 95% CI : 2 2.6-60.8, P < 0.0001), and diagnosed with AIDS because of extrapulmona ry tuberculosis (32.0% versus 14.7%, P < 0.001). Among IVDU, those wit h prison histories were more frequently males (OR: 2.2; 95% CI : 1.6-2 .9), lived in the poorest district of Barcelona more frequently than i n the richest district (OR: 6.6; 95% CI : 3.4-12.9) and presented with extra-pulmonary tuberculosis more frequently than Pneumocystis carini i pneumonia (OR: 1.7; 95% CI : 1.2-2.4). Longer survival in the prison group did not persist when adjusted for age and AIDS-defining disease . Those with prison histories who presented with AIDS with only extrap ulmonary tuberculosis had better probability of survival than those wh o presented only with P. carinii pneumonia (P < 0.001). Conclusions. A IDS patients in Barcelona with prison histories tended to be younger, more likely to be IVDU, and to present with extrapulmonary tuberculosi s as an AIDS-defining illness than other patient groups. Better surviv al appears to be related to age and AIDS-defining illnesses in the pri son group. The fact that half the IVDU AIDS cases had prison histories has important implications for the care and prevention of HIV, tuberc ulosis, and drug abuse in comparable prison settings.