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 imprisonment. Methods. AIDS patients diagnosed in Barcelona between 1988 and 1993 were studied. Those with prison histories were compared to those without, with respect to epidemiological variables, including survival analysis. Results. 28.5% of 2336 AIDS patients, 49.4% of intravenous drug users (IVDU) and only 2.6% of homosexuals who were not IVDU had a prison history. Those with prison histories, compared to those without, 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 : 22.6-60.8, P < 0.0001), and diagnosed with AIDS because of extrapulmonary tuberculosis (32.0% versus 14.7%, P < 0.001). Among IVDU, those with 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 in the richest district (OR: 6.6; 95% CI : 3.4-12.9) and presented with extra-pulmonary tuberculosis more frequently than Pneumocystis carinii 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 extrapulmonary tuberculosis had better probability of survival than those who presented only with P. carinii pneumonia (P < 0.001). Conclusions. AIDS patients in Barcelona with prison histories tended to be younger, more likely to be IVDU, and to present with extrapulmonary tuberculosis as an AIDS-defining illness than other patient groups. Better survival appears to be related to age and AIDS-defining illnesses in the prison group. The fact that half the IVDU AIDS cases had prison histories has important implications for the care and prevention of HIV, tuberculosis, and drug abuse in comparable prison settings.