September 14, 2005
INMATES WITH AIDS, HEPATITIS C, OR TUBERCULOSIS
By: George Coppolo, Chief Attorney
You asked how many sentenced inmates in the Connecticut prison system have AIDS; how the Department of Correction (DOC) determined this; and how much DOC spends on medical treatment. You asked for similar information for sentenced inmates with Hepatitis C, and Tuberculosis (TB). Finally, you asked how Connecticut's approach compares with other states.
Pat Ottolini, DOC Director of Health and Addiction Services, provided us with the following information. Currently there are 425 sentenced offenders with HIV/AIDS. DOC is treating 350 of them. DOC does not automatically or periodically test inmates for HIV/AIDS. It tests only if the inmate or a DOC physician requests it. During the past 12 months, DOC conducted 2,735 HIV tests with 14 confirmed positive results. The cost for HIV treatment is about $1,000 per inmate per month. This does not include lab studies or personnel costs. The cost for drugs is over $4,000,000 a year.
Ottolini also advised us that DOC does not conduct mandatory or routine testing for Hepatitis C. It conducts a test only if a DOC doctor refers the offender for testing. If an inmate asks for a test, it is done so only after a consultation with, and the approval of, a doctor. If the test is positive the offender is assessed and referred to an Infectious Disease Specialist. Offenders who test positive receive education and counseling. Drug treatment is offered to appropriate candidates. On a monthly average just under 20 offenders receive drug treatment for Hepatitis C. The cost is about $3000 per month per offender. This includes drugs and lab studies. The cost is about $720,000 per year.
According to Ottolini, no sentenced inmates currently have TB. DOC screens all offenders for TB when they are first admitted and annually thereafter.
A recent report in Correction Compendium (November/December 2004) compared the incidence of and screening for HIV/AIDS, Hepatitis C, and TB in prisons in each state for 2003.
Regarding HIV/AIDS, the study found that 22 states test inmates when they are first admitted to prison; 41 states including Connecticut, test at the inmate's request; and 43, including Connecticut, test at a doctor's request. The study reported that in 2003, 3.1% of Connecticut's prison population had tested positive for HIV/AIDS. Two states reported a higher percentage-Arizona at 5%, and Florida at 4.2%. Table 4 of the attached study reports the testing for and incidence of HIV/AIDS in each state's prison system, and the treatment offered. (Attachment 1)
Regarding Hepatitis C, nine states test inmates when they are first admitted to prison; 28 states, including Connecticut, test at the inmate's request; and 38 states, including Connecticut, test at a doctor's request. The reported rates for 2003 vary from a high of 33% in California to at low of less than .5% in Missouri. Connecticut did not answer this question for this study, Ottolini said she would try to get us the 2003 figure and we will forward it to you as soon as we receive it. Table 5 of the attached study reports the incidence of, testing for, and treatment offered. (Attachment 2)
Regarding TB, all but a few states test inmates when they are first admitted to prison; 13 states test at an inmate's request; 28 test at a doctor's request; and 22, including Connecticut, test annually. According to this study, 3.5% of the prison population had tested positive. Eleven states reported a higher percentage. Table 6 of the attached study reports the incidence of, testing for, and treatment offered for inmates with TB. (Attachment 3)
The following information was taken directly from a March 2005 report of the US Department of Health and Human Services, National Institute of Health.
AIDS (acquired immunodeficiency syndrome) was first reported in the United States in 1981 and has since become a major worldwide epidemic. AIDS is caused by human immunodeficiency virus (HIV). By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. People diagnosed with AIDS may get life-threatening diseases called opportunistic infections, which are caused by microbes such as viruses or bacteria that usually do not make healthy people sick.
Early Symptoms of HIV Infection
Many people do not have any symptoms when they first become infected with HIV. But some have a flu-like illness within a month or two after exposure to the virus. These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.
More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults, or within 2 years in children born with HIV infection. This period of "asymptomatic" infection varies greatly in each individual. Some people may begin to have symptoms within a few months, while others may be symptom-free for more than 10 years.
Even during the asymptomatic period, the virus is actively multiplying, infecting, and killing cells of the immune system. The virus can also hide within infected cells and lay dormant. The virus slowly disables or destroys these cells without causing symptoms. As the immune system worsens, a variety of complications start to take over.
What is AIDS?
The term AIDS applies to the most advanced stages of HIV infection. CDC developed official criteria for the definition of AIDS and is responsible for tracking the spread of AIDS in the United States. In addition, the definition includes 26 clinical conditions that affect people with advanced HIV disease. Most of these conditions are opportunistic
infections that generally do not affect healthy people. In people with AIDS, these infections are often severe and sometimes fatal because the immune system is so ravaged by HIV that the body cannot fight off certain bacteria, viruses, fungi, parasites, and other microbes.
People with AIDS are also particularly prone to developing various cancers, especially those caused by viruses such as Kaposi's sarcoma and cervical cancer, or cancers of the immune system known as lymphomas. These cancers are usually more aggressive and difficult to treat in people with AIDS. Signs of Kaposi's sarcoma in light-skinned people are round brown, reddish, or purple spots that develop in the skin or in the mouth. In dark-skinned people, the spots are more pigmented.
Early HIV infection often causes no symptoms, but doctors can usually diagnose it by testing blood for the presence of antibodies (disease-fighting proteins) to HIV. HIV antibodies generally do not reach noticeable levels in the blood for 1 to 3 months following infection. It may take the antibodies as long as 6 months to be produced in quantities large enough to show up in standard blood tests. Thus, to determine whether someone has been recently infected (acute infection), doctors can screen for the presence of HIV genetic material.
The Food and Drug Administration (FDA) has approved a number of drugs for treating HIV infection. The first group of drugs used to treat HIV infection, called nucleoside reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus making copies of itself. These drugs may slow the spread of HIV in the body and delay the start of opportunistic infections.
FDA also has approved a second class of drugs for treating HIV infection. These drugs, called protease inhibitors, interrupt the virus from making copies of itself at a later step in its life cycle.
FDA also has introduced a third new class of drugs, known at fusion inhibitors, to treat HIV infection. It is designed for use in combination with other anti-HIV treatment. It reduces the level of HIV infection in the blood and may be active against HIV that has become resistant to current antiviral treatment schedules.
The following information was taken directly from the National Digestive Disease Information Clearinghouse website. (We have enclosed a complete copy of the information about Hepatitis C on the site.)
The Hepatitis C virus is a type of hepatitis that is mostly transmitted intravenously, through a blood transfusion, sharing needles while using illegal drugs, or an accidental "needle-stick" in a health care setting. It is one of the most important causes of chronic liver disease in the United States. It accounts for about 15 percent of acute viral hepatitis, 60 to 70 percent of chronic hepatitis, and up to 50 percent of cirrhosis, end-stage liver disease, and liver cancer. Almost 4 million Americans, or 1.8 % of the U.S. population, have antibodies to HCV (anti-HCV), indicating ongoing or previous infection with the virus. Hepatitis C causes an estimated 10,000 to 12,000 deaths annually in the United States.
At least 75 percent of patients with acute hepatitis C ultimately develop chronic infection, and most of these patients have accompanying chronic liver disease.
Chronic Hepatitis C varies greatly in its course and outcome. At one end of the spectrum are patients who have no signs or symptoms of liver disease and completely normal levels of serum liver enzymes. Liver biopsy usually shows some degree of chronic hepatitis, but the degree of injury is usually mild, and the overall prognosis may be good. At the other end of the spectrum are patients with severe hepatitis C who have symptoms, HCV in serum, and elevated serum liver enzymes, and who ultimately develop cirrhosis and end-stage liver disease. In the middle of the spectrum are many patients who have few or no symptoms, mild to moderate elevations in liver enzymes, and an uncertain prognosis.
Chronic Hepatitis C can cause cirrhosis, liver failure, and liver cancer. Researchers estimate that at least 20 % of patients with chronic hepatitis C develop cirrhosis, a process that takes at least 10 to 20 years. After 20 to 40 years, a smaller percentage of patients with chronic disease develop liver cancer. Liver failure from chronic hepatitis C is one of the most common reasons for liver transplants in the United States. Hepatitis C is the cause of about half of cases of primary liver cancer in the developed world. Men, alcoholics, patients with cirrhosis, people over age 40, and those infected for 20 to 40 years are more likely to develop liver cancer.
Clinical Symptoms and Signs
Many people with chronic Hepatitis C have no symptoms of liver disease. If symptoms are present, they are usually mild, nonspecific, and intermittent. They may include fatigue, mild right-upper-quadrant discomfort or tenderness ("liver pain"), nausea, poor appetite, or muscle and joint pains. Similarly, the physical exam is likely to be normal or show only mild enlargement of the liver or tenderness.
Once a patient develops cirrhosis or if the patient has severe disease, symptoms and signs are more prominent. In addition to fatigue, the patient may complain of muscle weakness, poor appetite, nausea, weight loss, itching, dark urine, fluid retention, and abdominal swelling.
Hepatitis C is most readily diagnosed when serum aminotransferases are elevated and anti-HCV is present in serum.
The therapy for chronic hepatitis C has evolved steadily since alpha interferon was first approved for use in this disease more than 10 years ago. At the present time, the optimal regimen appears to be a 24- or 48-week course of the combination of pegylated alpha interferon and ribavirin.
The following information was taken directly from the National Institute of Health US Department of Health and Human Services Tuberculosis fact sheet website.
TB is a leading killer of young adults worldwide. About 2 billion people—one-third of the world's population—are infected with the TB bacterium, M. tuberculosis. TB is a chronic bacterial infection. It is spread through the air and usually infects the lungs, although other organs are sometimes involved. Most persons that are infected with M. tuberculosis harbor the bacterium without symptoms but many develop active TB disease. Each year, 8 million people worldwide develop active TB and 3 million die.
In the United States, in 2001, the number of active TB cases (infection with full-blown disease symptoms) was nearly 16,000. In addition to those with active TB, an estimated 10 to 15 million people in the United States are infected with M. tuberculosis without displaying symptoms (latent TB) and about one in ten of these individuals will develop active TB at some time in their lives.
TB affects minorities disproportionately: 54% of active TB cases in 1999 were among African-American and Hispanic people, with an additional 20 % found in Asians.
TB is primarily an airborne disease. It is spread from person to person in tiny microscopic droplets when a TB sufferer coughs, sneezes, speaks, sings, or laughs. Only people with active disease are contagious.
One in ten people that are infected with M. tuberculosis may develop active TB at some time in their lives. The risk of developing active disease is greatest in the first year after infection, but active disease often does not occur until many years later.
Early symptoms of active TB can include weight loss, fever, night sweats, and loss of appetite, or they may be vague and go unnoticed by the affected individual. One in three patients with TB will die within weeks to months if the disease is not treated. For the rest, their disease either goes into remission (halts) or becomes chronic and more debilitating with cough, chest pain, and bloody sputum.
Symptoms of TB involving areas other than the lungs vary, depending upon the organ affected.
Doctors can identify most people infected with M. tuberculosis with a skin test. They will inject a substance under the skin of the forearm. If a person has an obvious reaction to the skin test, other methods can help to show if the individual has active TB. In making a diagnosis, doctors rely on symptoms and other physical signs, a person's history of exposure to TB, and x-rays that may show evidence of M. tuberculosis infection.
The doctor also will take sputum and other samples, to see if the TB bacteria will grow in the lab. If bacteria are growing, this positive culture confirms the diagnosis of TB. Because M. tuberculosis grows very slowly, it can take four weeks to confirm the diagnosis. An additional two to three weeks usually are needed to determine which antibiotics the bacteria are susceptible to.
With appropriate antibiotic treatment, TB can be cured in more than nine out of ten patients.
Successful treatment of TB depends on close cooperation between the patient and doctor and other health care workers. Treatment usually combines several different antibiotic drugs, which are given for at least six months, sometimes for as long as 12 months.