Determinants of HIV-related survival among Texas prison inmates

Research indicates that being incarcerated adversely affects disease progre ssion and overall health status. Because HIV infection is a growing problem among prison populations in the United States, understanding how incarcera tion affects HIV-related survival patterns is critical. The present study e xamined determinants of HIV-related survival in a cohort of 2380 Texas Depa rtment of Criminal Justice (TDCJ) inmates who were treated for HIV/AIDS, da ting from January 1, 1992 and June 31, 1997. Assessment of the study factor s indicated that there were no substantial violations of the assumptions of the Cox's proportional hazards (PH) model in the present study population. Furthermore, to address the potential problem of censoring-related bias, m ortality information was collected on all inmates who were paroled on the b asis of disease status. The present study's findings indicate that the foll owing factors were associated with significant decreases in HIV-related sur vival in the TDCJ prison population: male gender, older age, self-report of no known HIV transmission risk factors, and presence of cytomegalovirus (C MV), Mycobacterium avium complex (MAC), and Pneumocystis carinii pneumonia. Moreover, survival decreased in a monotonic fashion with decrease in basel ine CD4 count. While the majority of the present study's findings were cons istent with those reported for nonincarcerated populations, it will be impo rtant for investigators to assess whether these findings persist among futu re cohorts of prison inmates.