Washington (H24N). William O'Brien, MD, of the University of Texas Medical Branch at Galveston is reporting that almost half of the 3-4 percent of Texas prison inmates who enter the correctional system HIV-positive have drug-resistant strains of the disease compared to 35 percent of AIDS patients in general.

In an article in the Dallas Morning News, O'Brien expressed concern that drug-resistant HIV was being circulated in the Texas prison system and could pose a significant problem for the general population once these prisoners are released. O'Brien is comparing blood samples taken from HIV-positive inmates of the Texas Department of Criminal Justice prisons in 1998 with samples taken from HIV-positive patients seen in the University of Texas medical school's clinics that year. He will test 718 samples in all, but discussed the results of an analysis of almost 500 samples last week in Toronto during the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy, a meeting on infectious diseases hosted by the American Society for Microbiology.

About 48 percent of the inmate samples were resistant to the anti-AIDS drug 3TC compared to about 35 percent of the samples from university clinic patients; but inmate samples were less resistant to AZT. O'Brien plans to test resistance to several other drugs before the study is finished.

Infectious diseases become resistant to drug treatment when patients do not take the full course of the effective drug prescribed or when they take it irregularly. Every microbe has naturally occurring mutants (like black wolves or white squirrels) within each strain that are less responsive to the drug.

Drug effectiveness is based on keeping the amount of medicine that kills the microbes in the bloodstream at all times for the number of days it takes to kill all the unwanted organisms in the body. If drug doses are skipped, blood levels of the drug do not remain constant and the hardier members of the microbial community have a chance to survive, as they do when not enough of the drug is taken. Most of the microbial survivors are the less responsive mutants that start to flourish because they now have uncontested access to all the body's resources. This is called acquired resistance. When the new population of resistant microbes is strong enough to spread to other organisms and infect them, they create a disease that is drug-resistant at the outset and has what is called "primary" resistance.

The problem in the Texas prisons has been attributed to acquired resistance. Inmates are moved from one prison to another and sometimes their drugs don't follow them or are delayed. Inmates also do not like to be seen taking too many drugs because they are afraid it will reveal their HIV-positive status to the other members of the prison population.

People who are incarcerated usually have higher rates of HIV infection than the general public because many use intravenous drugs or engage in risky sexual behavior before they are arrested. Once they enter the prison system, their disease has a much greater chance to become drug-resistant, and if they spread it to other inmates they have a greater chance of spreading a resistant strain.

O'Brien has documented what he believes is the first known case of drug-resistant HIV to be transmitted in prison. The man had several negative HIV tests and then had a positive one in February of 1997. Less than a year later, doctors found nine genetic mutations of the strain of HIV he carried, some of which cause drug resistance, even though the man had not yet taken any medicine for his condition.

O'Brien's research points up the need for better inmate education on AIDS transmission, and also raises concerns about the transmission of other infectious diseases associated with AIDS, such as tuberculosis.

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