Treatment of hepatitis C can be successful in a prison population

By Andrew Czyzewski, medwireNews Reporter

Incarcerated individuals with chronic hepatitis C virus (HCV) infection can be successfully treated with pegylated interferon and ribavirin, achieving similar rates of treatment completion and sustained viral response to that of infected individuals in the community, study results show.

Given the prevalence of HCV infection in the incarcerated population, which is as high as 31.0%, relative to around 1.6% of the general population, the researchers suggest that "anti-viral treatment while in prison is the optimal time for treatment to reverse a public health crisis."

Although previous data suggest that HCV treatment in the prison population is feasible and safe, no study has compared treatment with pegylated interferon and ribavirin between contemporaneous incarcerated and nonincarcerated patients treated in the same clinical center until now.

Michael Lucey (University of Wisconsin, Madison, USA) and colleagues therefore performed a study of 388 incarcerated and 521 nonincarcerated HCV-infected patients evaluated for treatment at University of Wisconsin clinics between January 2002 and December 2007.

Lucey et al found that the incarcerated patients were more likely to be male (93.0 vs 64.5%), African-American (25.8 vs 11.7%), and were significantly more likely to have a history of alcohol (59.4 vs 45.7%) or drug (67.5 vs 44.8%) abuse. Conversely, a greater proportion of the community population had experienced prior treatment failure (10.4 vs 1.5%).

Overall, 386 (69.8%) patients completed a full treatment course. A similar proportion of incarcerated and nonincarcerated patients completed a full treatment course (75.0 and 68.6%, respectively).

Likewise, a sustained viral response (SVR) was achieved in a similar number of incarcerated (n= 97; 42.9%) and nonincarcerated patients (n=115; 38.0%).

Stepwise logistic regression analysis revealed four significant predictors of increased SVR: full treatment course (odds ratio [OR]=31.95); nongenotype 1 virus (OR=3.48); HIV negativity (OR=2.85); and younger age at treatment start (aged 44 years and below vs 45 years and above, OR=0.96).

Incarceration status, when added to this model, was not associated with the probability of achieving SVR.

Discussing the findings in Hepatology, Lucey and team comment: "Prison potentially offers access to appropriate HCV care to a population with numerous socioeconomic, psychiatric, and substance abuse risk factors.

"We suggest that the use of telemedicine helped forge a therapeutic link between incarcerated patients, their care-givers in the Department of Corrections and the medical professionals in the academic medical center which maximized treatment completion rates."

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