Evaluation of the Federal Bureau of Prisons Protocol for Selection of Which Hepatitis C?Infected Inmates Are Considered for Treatment

Abstract

The Federal Bureau of Prisons limits hepatitis C therapy to those inmates with certain biochemical abnormalities. To evaluate this protocol, an analysis was done on data collected on hepatitis C infected inmates in the Louisiana Department of Corrections. A quality assurance database of hepatitis C infected inmates evaluated in the Louisiana Department of Corrections was reviewed for liver biopsy and laboratory results. Patients were compared as to whether they would have been biopsied under the Federal Bureau of Prisons protocol and if there were histologic differences between those who would and those who would not have been biopsied. Of 490 inmates biopsied, 26% (129) had an alanine aminotransferase level between one and two times the upper limit of normal without other biochemical abnormalities. If treating stages 2-4, 48% of these would qualify for treatment (15% if treating stages 3-4). There was no statistical difference between this group and either the group with an alanine aminotransferase level between one and two times the upper limit of normal and with other laboratory abnormalities or the group with an alanine aminotransferase level greater than or equal to two times the upper limit of normal and without other abnormalities. In the Louisiana Department of Corrections, the Federal Bureau of Prisons protocol was neither sensitive nor specific enough at identifying those that should be considered for hepatitis C therapy.

Promoting HCV Treatment Completion for Prison Inmates: New York State's Hepatitis C Continuity Program

“…HCV is possibly the most prevalent bloodborne infection in prisons in the United States. [7][8][9][10][11] An increase in deaths from liver disease among inmates has been observed. 12 The need to identify and treat inmates with HCV has been highlighted by both correctional and public health officials.…”

Controversies in and challenges to our understanding of hepatitis C

“…Attempts to modify the prison experience in a way that would reduce risk of infection with blood-borne viruses and optimise the testing for and management of the HCV and HBV problems in prison do not meet support in any consistent way. These problems are experienced in Australia and around the globe [68][69][70][71][72][73][74][75][76][77][78] . It is encouraging that progress is being made in different ways in different countries.…”