Feasibility of Treating Hepatitis C in a Transient Jail Population

MacDonald, Ross; Akiyama, Matthew J.; Kopolow, Aimee; Rosner, Zachary; McGahee, Wendy; Joseph, Rodrigue; Jaffer, Mohamed A.; Venters, Homer

doi:10.1093/ofid/ofx142

Cited by 27 publications

(26 citation statements)

References 5 publications

(5 reference statements)

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“…Thus, efforts should be made to offer a broader HCV treatment access to PWID with a final aim of preventing efficiently further transmission. Jail constitutes a critical component of the public health response to HCV eradication and recent studies suggest that DAA therapy in jail is feasible and the access to DAA may preserve the efficacy of community‐initiated HCV regimens …”

Section: Discussionsupporting

confidence: 91%

Real‐life glecaprevir/pibrentasvir in a large cohort of patients with hepatitis C virus infection: The MISTRAL study

Persico

Aglitti

Milella

et al. 2019

Liver International

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Background and aims:It is paramount to identify predictors of treatment failure with direct antiviral agents in 'field-practice' patients, including people who inject drugs (PWID). Data on the efficacy of glecaprevir/pibrentasvir (GLE/PIB) in a field-practice scenario are scant. The multicentre MISTRAL study enrolled 1177 patients, including PWID, to assess real-life efficacy and safety of GLE/PIB and to identify the predictive factors for this treatment. Methods:This was a prospective, longitudinal study. The outcome variable was the rate of sustained virological response (SVR) at week 12.Results: A total of 123 patients (10%) were infected from hepatitis C virus (HCV) 3.METAVIR fibrosis score was F4 in 104 subjects (9%); 118 patients (10%) were PWID.Overall, 1163/1177 (99%) patients achieved SVR. The baseline clinical factors discriminating between treatment success and treatment failure were age at treatment (P = 0.031) and creatinine level (P = 0.034). SVR rates were not influenced by gender, substance abuse, previous treatment, treatment duration, fibrosis or chronic kidney disease stage. Compared with non-substance users, the 118 PWID exhibited a significantly different genotype pattern distribution (χ 2 < 0.001). A total of 40/118 (33.9%) of substance users were HCV3 compared to 83/1056 (7.9%) non-substance users.Only 6 patients (0.5%) reported a serious adverse event. Conclusions:The MISTRAL study provides evidence of GLE/PIB efficacy in a fieldpractice scenario in a highly epidemic HCV area in southern Italy; it unveiled significant differences in genotype distribution among the most underserved and difficult-to-treat patient subgroups including PWID. K E Y W O R D S cirrhosis, direct-acting antiviral, efficacy, HCV genotype, substance abuse Keypoints • The MISTRAL study shows that glecaprevir/pibrentasvir is effective for the treatment of hepatitis C virus in a field-practice scenario in a highly epidemic area in southern Italy. Handling editor: Alessio Aghemo S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Persico M, Aglitti A, Milella M, et al. Real-life glecaprevir/pibrentasvir in a large cohort of patients with hepatitis C virus infection: The MISTRAL study. Liver Int.

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Section: Discussionsupporting

confidence: 91%

Real‐life glecaprevir/pibrentasvir in a large cohort of patients with hepatitis C virus infection: The MISTRAL study

Persico

Aglitti

Milella

et al. 2019

Liver International

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“…Implementing DAA therapy for HCV has been successful with high cure rates in prison settings [ 14 ], but little has been published from jail settings. Treatment with DAA therapy in NYC jails is feasible as reported in a prior study from our system [ 15 ], but this study did not report SVR12 data and surveillance for reinfection events, due to lack of longitudinal follow-up.…”

mentioning

confidence: 99%

Outcomes of Hepatitis C Virus Treatment in the New York City Jail Population: Successes and Challenges Facing Scale up of Care

Chan

Schwartz

Kaba

et al. 2020

Open Forum Infectious Diseases

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Background The population detained in the New York City (NYC) jail system bears a high burden of hepatitis C virus (HCV) infection. Challenges to scaling up treatment include short and unpredictable lengths of stay. We report on the clinical outcomes of direct-acting antiviral (DAA) treatment delivered by NYC Health + Hospitals / Correctional Health Services (CHS) in NYC jails from 2014-2017. Methods We performed a retrospective observational cohort study of HCV patients with detectable HCV RNA treated with DAA therapy while in NYC jails. Some patients initiated treatment in jail while others initiated treatment in the community and were later incarcerated. Our primary outcome was sustained virologic response at 12 weeks (SVR12). Results There were 269 patients included in our cohort, with 181 (67%) initiating treatment in jail and 88 (33%) continuing treatment started in the community. SVR12 virologic outcome data was available for 195 (72%) individuals. Of these, 172 (88%) achieved SVR12. Patients who completed treatment in jail were more likely to achieve SVR12 relative to those who were released on treatment (adjusted risk ratio 2.93, 95% CI 1.35, 6.34). Of those who achieved SVR12, 114 (66%) had a subsequent viral load checked. We detected recurrent viremia in 18 (16%) of these individuals, which corresponded to 10.6 cases per 100 person-years of follow-up. Conclusions HCV treatment with DAA therapy is effective in a jail environment. Future work should address challenges related to discharging patients while they are on treatment, loss to follow-up, and a high incidence of probable reinfection.

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“…Despite the quick turnover and inability to administer and track the full course of DAAs, short-term correctional settings serve as an opportunity to continue HCV-care for those already on treatment but also have the potential to engage a large number of individuals unaware of their status into care, and provide testing and education for those at risk for HCV. A study conducted in the New York City jail system found viral load suppression for over 90% of patients including those who initiated treatment prior to incarceration and those who initiated treatment in the jails, demonstrating the feasibility of DAA access in short-term settings [ 8 ].…”

Section: The Hcv Care Cascade In Correctional Settings: Missed Opportmentioning

confidence: 99%

Hepatitis C in the criminal justice system: opportunities for global action in the era of viral hepatitis elimination

Akiyama

2020

BMC Med

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Feasibility of Treating Hepatitis C in a Transient Jail Population

Cited by 27 publications

References 5 publications

Real‐life glecaprevir/pibrentasvir in a large cohort of patients with hepatitis C virus infection: The MISTRAL study

Real‐life glecaprevir/pibrentasvir in a large cohort of patients with hepatitis C virus infection: The MISTRAL study

Outcomes of Hepatitis C Virus Treatment in the New York City Jail Population: Successes and Challenges Facing Scale up of Care

Hepatitis C in the criminal justice system: opportunities for global action in the era of viral hepatitis elimination

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