Dear Correctional Colleagues:

As AIDS therapy marches into the new millennium, we have witnessed a dramatic decrease in AIDS mortality and a corresponding increase in the number of patients living with AIDS. There is no doubt that Highly Active Antiretroviral Therapy (HAART) has benefited HIV-infected persons over the years, however the number of AIDS cases is still high and opportunistic infections (OIs) are still a common occurrence, particularly in the correctional population.

This month's lead article by Dr. David Paar discusses new trends and clinical concepts in the occurrence of OIs that have accompanied effective antiretroviral therapy. This informative review provides up-to-date information on prevention and treatment of OIs. Immune reconstitution ­ a concept that often receives too little attention in HIV-disease research ­ is given its due by Dr. Paar in his accessible explication of immunotherapeutic strategies that can be used following HAART-associated immune reconstitution. A review of correctional-specific issues surrounding prevention and treatment of OIs, as well as educational initiatives in jails and prisons, is a keen reminder that education is a continuous process, often most effective when delivered in tailor-made and creative ways.

In the Spotlight for October Ms. Abby Dees provides timely discussion of clustering in U.S. correctional facilities. This article weighs the pros and cons of the practical aspects of segregating HIV-infected inmates and describes the areas of law that address this delicate and litigious issue.

After reading this month's issue you should be more familiar with the prevention and treatment of OIs since the advent of HAART, concepts in immune reconstitution and the subtleties of multi-drug resistant tuberculosis. Next month's HEPP Report will feature comprehensive coverage of the ICCAAC (Interscience Conference on Antimicrobial Agents and Chemotherapeutics), the 41st Annual Meeting of the IDSA (Infectious Diseases Society of America), the NCCHC (National Conference on Correctional Healthcare), and the CEECDISP (Central and Eastern European Conference on Drug Infection Services in Prison).

Sincerely yours,

Joseph Bick, MD       Julia Noguchi, MA
Co-Chief Editor         Managing Editor

031001
HEPP2003-1001

©1997,1998,1999,2000,2001,2002, 2003. The recently formed HIV Education Prison Project (HEPP) is a medical education program that targets a growing population, inmates in correctional facilities, that has been underserved in HIV care. It is part of the Brown University AIDS Program. Permission to use and reproduce portions of this newsletter is hereby granted provided that author and publication are fully credited and both copyright and permission notice appear with reprinted material. Inquiries may be directed to heppnews@brown.edu. Website: HIV Education Prison Project.

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