By Liz Highleyman

Hepatitis C virus (HCV) infection is common in prisons, largely due to its association with injection drug use. It is estimated that more than one-third of people in the U.S. with hepatitis C pass through the correctional system each year. Some practitioners are hesitant to offer interferon-based treatment to prisoners, however, viewing them as a challenging or "difficult to treat" population.

To shed further light on the validity of this assumption, D.S. Maru from Yale University School of Medicine and colleagues studied hepatitis C treatment outcomes in a correctional setting; results were published in the October 1, 2008 issue of Clinical Infectious Diseases.

Between 2000 and 2006, the investigators analyzed chronic hepatitis C patients in the Connecticut Department of Correction who were treated with pegylated interferon plus ribavirin. They assessed rates of sustained virological response (SVR, or continued undetectable HCV RNA 6 months after completion of therapy), hospitalization, and use of medications to manage psychiatric disorders and anemia.

Results

• Of 138 treatment-naive patients referred for treatment, 68 (49%) were approved.

• The overall SVR rate was 47.1%:

• 43.1% for patients with HCV genotype 1;

• 58.8% for those with genotypes 2 or 3.

• Only 9 individuals (13%) discontinued treatment due to adverse effects.

• Multiple regression analysis revealed that not achieving SVR was correlated with genotype 1 infection plus cirrhosis (adjusted odds ratio 12.9) and major depression at the start of treatment (adjusted odds ratio 3.4).

• However, SVR was not significantly associated with HIV coinfection, high baseline HCV RNA (? 400,000 IU/mL), or black race.

• Compared with baseline, more patients were prescribed a new mood stabilizer (2.2 vs 0.8 prescriptions per person-year) or an opioid (1.8 vs 0.5 prescriptions per person-year) during anti-HCV treatment.

• There was no change, however, in the rate of prescription of benzodiazepines or antipsychotic medications.

In conclusion, the study authors wrote, "These results support the feasibility and clinical effectiveness of [pegylated interferon plus ribavirin] for the treatment of chronic HCV infection in correctional facilities."

The SVR rates observed in this study were somewhat lower than those seen in non-prison populations, especially for genotypes 2/3, but still a large proportion of patients achieved sustained response.

It is unexplained, however, why HIV coinfection, high pre-treatment HCV viral load, and black race did not seem to significantly influence outcomes in this analysis, since all 3 factors have been linked to poor response in other studies

10/07/08

Reference
DS Maru, RD Bruce, S Basu, and others. clinical outcomes of hepatitis C treatment in a prison setting: feasibility and effectiveness for challenging treatment populations. Clinical Infectious Diseases 47(7): 952-961. October 1, 2008. (Abstract).