Combined pegylated interferon and ribavirin for the management of chronic hepatitis C in a prison setting

Abstract

The elevated frequency of chronic hepatitis C virus (HCV) infection found among prison inmates, and the availability of improved pharmacological cure for this potentially life-threatening disorder, make investigations conducted in this somewhat neglected area very relevant, since only a few, openlabel experiences have been reported till now. In the metropolitan prison of Bologna (Italy), HCV seroprevalence was found to be over 31% in 2003, so that a pilot feasibility study based on treatment with pegylated interferon plus ribavirin was initiated, after careful counseling carried out by a joint commission of health care personnel of the correctional facility and infectious diseases consultants. Thirty-nine patients were enrolled, and despite expected dropouts due to difficulty in maintaining the same level of counseling pressure over time, and the particularly unfavorable climatic conditions during Summer 2003, a sustained virological response was obtained for 8 out of the 21 patients who remained evaluable after the first three month follow-up, although we need to take into account that a high percentage of subjects (67%) were selected for therapy due to their favorable HCV genotypes (types 2 and 3). Our preliminary experience shows that an intrinsically complicated therapy, such as the administration of pegylated interferon plus ribavirin, can attain a relatively high success rate, even in a very unfavorable and uncomfortable context, such as a prison, where only enforced counseling, active participation of institutional health care operators, and patient's willingness to maintain an elevated level of co-operation and adherence, can overcome most structural and relational difficulties. Key Words: Chronic hepatitis C, pegylated interferon, ribavirin, management, inmates, prison.From an epidemiological point of view, prison inmates represent a relevant health problem, since the seroprevalence for hepatitis C virus (HCV) is very high in this population. Surveys conducted in the U.S.A. show a prevalence in inmates ranging from 16% up to 42% [1], while similar experiences carried out in Spain [2], England [3], and France [4], detected a frequency of 47.9%, 30%, and 30.3%, respectively. A recent Italian multicenter study disclosed a mean HCV prevalence of 38%, with broad variations found among the different institutions that participated in the very recent polycentric survey in Italy: 28% up to 50% [5]. In our recent epidemiological investigation involving 408 inmates at Bologna metropolitan prison, we found a seroprevalence rate for HCV of 31.1% [6].While active action against the spread of HCV infection spread is important for the general population, HCV serological screening is of utmost importance, in order to have an early diagnosis of possibly severe and transmissible, but treatable, infectious diseases, as well as to trigger a educative and cultural process that leads prisoners to be more aware of the relevance of preventive measures, and therapeutic needs.

Prevalence and epidemiological correlates and treatment outcome of HCV infection in an Italian prison setting

“…To further complicate HCV treatment in prison setting, an association between psychiatric disorders and hepatitis virus prevalence among inmates has been described [23], as result of intravenous drug abuse. Report of patients with chronic hepatitis C and psychiatric diseases treated in prison with interferon and ribavirin suggest that the treatment is possible and can be associated with discrete rate of virologic success [6,7,9,24]. An integrated approach with psychiatric support, has been described to favorably overcome the problem of psychiatric disorders in correctional settings [6] and should be advocated for all HCV patients with psychiatric co-morbidities.…”

“…Data on treatment of HCV chronic hepatitis in prisons are limited to few observational studies [6-8], small case series have been published in Italy on this specific topic [9]. In general, only a minority of patients with hepatitis C in prison can complete a full course treatment as early patient’s release or side effects or concomitant pathologies have limited the access to treatment [7,8].…”

Prevalence and epidemiology of chronic hepatitis C among prisoners of Mato Grosso do Sul State, Brazil

“…A review of previously published international studies has shown a range between 1.5-47.9% (9)(10)(11)(12)(13). Previous Brazilian studies have demonstrated values from 6.3 to 41% (14)(15)(16)(17)(18)(19).…”

Treatment Outcomes With Pegylated Interferon and Ribavirin for Male Prisoners With Chronic Hepatitis C

“…Newer treatment regimens of pegylated IFN (PEG-IFN) plus RBV have improved sustained virologic response (SVR) rates compared with previous regimens in drug trials 20–22. To date, only 2 other studies have described HCV treatment with this currently accepted regimen in the incarcerated population—one a small study conducted in a metropolitan Italian prison and the other describing clinical outcomes in the Connecticut Department of Corrections 23,24. Both demonstrated acceptable treatment outcomes using PEG-IFN and RBV.…”