Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date. "Those who cannot remember the past are condemned to repeat it."
George Santayana, philosopher and poet
Dear Colleagues:
Consider the following from the recent report to congress entitled "The Health Status Of Soon To Be Released Inmates":
-The prevalence of latent tuberculosis infection (LTBI) among inmates is markedly increased
compared to the general population.
-Nationwide, >500,000 inmates with LTBI are released each year.
-The rate of active tuberculosis in jails is fifteen times that seen in the general population.
-One-third of those with active tuberculosis in this country have been recently incarcerated.
-Approximately 15% of those with HIV in this country have been recently incarcerated.
Unfortunately, it has become all too easy in the U.S. to become complacent about tuberculosis. A marked decrease in new cases over the past 30 years has led to a situation in which many clinicians rarely, if ever, encounter a case of active disease. In the U.S. correctional setting, we treat a disproportionate number of individuals who are infected with HIV and/or MTB. Those coinfected with these two pathogens are at a significantly increased risk for progressing from LTBI to active contagious disease. Just one such individual in an overcrowded, underventilated congregate living environment can quickly lead to an outbreak situation among staff, inmates, and visitors. Those who are latently infected can be identified and treated while incarcerated, preventing the future development of active disease and transmission to others. It is unlikely that this nation will achieve its TB elimination goals without the efforts of all of us who work in correctional settings.
This month, Deputy Editor Renee Ridzon (currently with the Bill and Melinda Gates Foundation and formerly of the CDC TB control branch) provides an update of new information in the field of tuberculosis. This month's HIV 101 is an extremely useful table for clinicians detailing dosing interactions between rifamycins and antiretroviral agents, while our spotlight focuses on the use of electronic medical records in the correctional healthcare setting.
Next month, a trio of HEPP Report editors will bring you the latest in information from this year's conference on retroviruses and opportunistic infections, to be held in San Francisco February 8-11. Thank you for your ongoing readership of HEPP Report, and please let us know how we can better serve you in the future.
Sincerely,
Joseph Bick, MD
040201
HEPP2004-0201
©1997,1998,1999,2000,2001,2002, 2004. IDCR, a forum for correctional problem solving, targets correctional administrators and HIV/AIDS and hepatitis care providers including physicians, nurses, outreach workers, and case managers. The editorial board and contributors to IDCR include national and regional correctional professionals, selected on the basis of their experience with HIV and hepatitis care in the correctional setting and their familiarity with current HIV and hepatitis treatment. 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 Julia_Noguchi@brown.edu. Website: IDCR - Infectious Diseases in Corrections Report (Formerly HEPP Report).
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