Prolonged incubation period of AIDS in intravenous drug abusers: epidemiological evidence in prison inmates.

Fourteen heterosexual inmates who developed acquired immunodeficiency syndrome (AIDS) while incarcerated in New York state prisons were studied. All 14 had regularly used illicit drugs intravenously in New York City prior to imprisonment. Leukocyte counts on admission to the state prison system--when all of these inmates were well--were depressed by one-third when compared with those in matched intravenous drug-using inmates used as controls (mean leukocyte counts, 4,430 vs. 6,320 cells/mm3, respectively; P less than .005); twelve (86%) of the 14 inmates who developed AIDS had counts of less than 5,000 cells/mm3, compared with only six (14%) of the 42 controls (P less than .00001). The 14 inmates developed AIDS symptoms a mean of 22.6 +/- 9.6 months after imprisonment. We conclude that leukopenia is frequently to be found in presymptomatic AIDS infection and that the minimum mean incubation period of AIDS in intravenous-drug abusers is quite prolonged.

Acquired immunodeficiency syndrome in male prisoners. New insights into an emerging syndrome.

Between September 1981 and June 1982, the acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia were diagnosed in seven previously healthy young men incarcerated for 5 to 38 months in New York State correctional facilities. All seven patients were anergic, six were lymphopenic, and all developed oral candidiasis. Immunologic evaluation in vitro showed profound defects in cellular immune function in patients tested, with inversion of the normal ratio of helper to suppressor T-cell populations in four of five patients studied. No underlying immunosuppressive disorder was found in any patient, including three patients who had postmortem examinations. Based on these cases, the incidence of this syndrome among inmates of New York State correctional facilities is estimated to be at least 20 out of 100 000 per year. None of the inmates was homosexual but all had used intravenous drugs extensively before incarceration. If intravenous drug use is a cause of the syndrome, then the epidemiologic findings of this study suggest a prolonged incubation period (mean, 14.6 months) before development of serious opportunistic infection. Recognition that certain prisoners are at high risk for the acquired immunodeficiency syndrome has important implications for the prison health-care system.