Dear Corrections Colleagues,

These are exciting times in HIV therapeutics. We are at the cusp of a major change in the treatment landscape of this infection with the eminent release of three new HIV medications. Two of these antiretrovirals use unique mechanisms to interrupt the virus life cycle and the third extends the utility of an older class of these drugs. Together they provide, almost literally, a new lease on life for those with multi-drug resistant HIV infection.

Too often in corrections we care for HIV-infected individuals with extensive treatment experience who have cycled in and out of prisons, jails and the streets - along the way receiving and stopping antiretrovirals. Not surprisingly, many of these individuals develop drug resistant virus that out paces the availability of active agents in the HIV armamentarium. With genotypes dripping in red, we scratch our heads, unsure what to do to help these people, many of whom are asking for another chance.

With a critical mass of recently and about to be approved potent HIV drugs it is becoming increasingly possible to craft effective regimens for those with such extensive drug resistance. In this issue of IDCR we highlight the features of the major new HIV therapies so that we in corrections can prepare for their arrival and apply them wisely when they do come to our formularies. We also asked Dr. Rafael Campo of the University of Miami School of Medicine, an expert in the clinical management of HIV, to report back from the International AIDS Society Meeting held in Sydney, Australia. He provides an in-depth review of the data regarding emerging and established HIV therapies as well as data presented on HIV and viral hepatitis co-infection.

As with any change to the standard existing procedures, correctional systems are tasked to consider how these developments and advances can be incorporated in a manner that best serves the needs of patients and is affordable. Over the coming months there will be continued discussions regarding the cost of newer HIV therapies and the expensive laboratory testing that, in the case of one of these drugs, is practically required prior to use.

We, as well as those who represent our interests, must make a loud and unequivocal call on the pharmaceutical and laboratory companies involved to not forget that these products will be used extensively in correctional systems. Systems with zero-sum budgets that must cover everything from bed sheets to Band-Aids. Prisons and jails that are often left behind when it comes to special pricing for low income patients. Facilities that care for a lot of drug resistant HIV-infected patients. It does no good for our colleagues in industry who spent fortunes to develop these drugs or our patients who need these drugs to survive if new these exciting HIV therapies go unused for the wont of a price that is fair and affordable.

Sincerely,

David A. Wohl, MD
Associate Professor of Medicine
Division of Infectious Diseases
AIDS Clinical Research Unit
University of North Carolina

Back to Top