Immunologic predictors of HIV-related survival among Texas prison inmates

Research indicates that being incarcerated adversely affects overall health status. Because HIV-infection is a growing problem among the U.S. prison population, understanding how incarceration affects HIV-related survival holds particular clinical and public health relevance. Moreover, while the prognostic roles of CD4 and CD8 lymphocyte count have been well documented in noninstitutionalized populations, little is known about how these factors operate to predict survival among prison populations. The present study examined immunologic determinants of HIV-related survival in a cohort of 752 Texas Department of Criminal Justice (TDCJ) inmates who were treated for HIV/AIDS between 1993 and 1996 at a large southwestern medical center. Survival analysis using proportional hazards modeling showed that: (1) the prognostic role of CD4 count among inmates was similar to previous findings among nonincarcerated populations; (2) the prognostic role of CD8 count was slightly weaker than that previously reported for nonincarcerated populations; and (3) inmates who exhibited high levels of both CD4 and CD8 count had a survival advantage over those who had a high score on only one of the two factors.