U,S, Department of Justice

Federal Bureau of Prisons

Federal Corectional Institution

11900 E. Cornell Ave.

Unit C

Aurora, CO 80014

April 16,2013

Honorable Marcia S. Kr iege r

United States District Court,

Alfred A. Arraj United States

901 19th St reet

Denver, Colorado 80202

District of col-orado

Courthouse

Re: Management of Inmates with Human fmnunode ficiency virus (HIV)

i-n the Federal Bureau of Prisons

Dear Judge Krieger:

I am vrriting j,n response to a request from the United States Attorney's

Office that I describe how an inmate with well controlfed HIV disease

might be cared for if incarcerated in the Federa.l- Bureau of Prisons

(BOP).

I am a board certified lnternist employed by the Eederal Bureau of

Prisons as the Regional Medical Director in the ldestern Region.

f have been employed by the Bureau of Prisons for the past fifteen

years where I have provided care for many inmates with comp.Iex medical

conditions. I received a Bachelor of Arts degree from Duke

University, graduated from medical school at the University of

Southern California and completed a residency in inLernal medicine

through the University of California Los Angeles.

I was given the hypothetical case of a 42 year old ma.Le who was

diagnosed trith HIV about thj.rty months ago. Currently hls disease

is well controlLed with Atripla. He has an undetectable viral load,

and a CD-4 count of 560. He submits to blood work every six months

to monitor his kidney and liver function, HIV viral load, and CD-4

count.

Management of an inmate such as the one described j-s considered a

routine health services function in the BOP. Currentl,y, there are

ATTACHMENT 8

Case No. 1:11-cr-00355-MSK Document 261 filed 04/18/13 USDC Colorado pg 1 of 2
just under 1500 HIV infected inmates in the BoP. An inmate such

as this would be classified as a Care Level 1 inmate who would be

eligible to be designated to any BoP facility appropriate for his

security c]-assif ication. Asymptomatic HIV infected inmates Iike this

are routinely housed in general popuLation.

Such an .inmate would be prescribed Atrip.la, which he would

self-administer from a supply given to him, Inmates such as this

routinely undergo Iaboratory monitoring of their kidney and Iiver

function, HIV viral load. CD-4 count and other medicalLy indicated

Iaboratory test.s every six months unless it 1s clinically indicated

to monitor them more freguently.

Shoutd an asymptomatic HIV infected inmate like this one develop

a medical complj-cation related to his disease that required expert

knowJ.edge to manage, he would either be evaluated by an infectious

dj.sease speciaList in the l-ocaI community, or via consuLtation with

Lhe Infeclious Disease service of the Mayo Clinic, with which Lhe

BoP has a sEanding arrangement.

while it woul-d not apply to Lhis case, BOP inmates wiEh advanced

HIV infection (AIDS) are normally designated to EMC RochesLer for

care. Currently there are 53 inmates with AIDS at FMC Rochester.

The Bureau of Prlsons j,s cornmitted to providing its inmates with

medical care which is consistent with community standards. f trust

this evaluatj"on satisfies your concerns. PLease f eel- free to contact

me at (303) 338-6588 if I may be of further assistance in this matter.

James Pelton, M. D.

Regional Medical, Di-rector, Western Reg ion

2

Case No. 1:11-cr-00355-MSK Document 261 filed 04/18/13 USDC Colorado pg 2 of 2