Incidence of Hepatitis C Infection among Prisoners by Routine Laboratory Values during a 20-Year Period

Abstract

BackgroundTo estimate the incidence of Hepatitis C virus (HCV) and the predictive factors through repeated routine laboratory analyses.MethodsAn observational cohort study was carried out in Quatre Camins Prison, Barcelona. The study included subjects with an initial negative HCV result and routine laboratory analyses containing HCV serology from 1992 to 2011. The incidence of infection was calculated for the study population and for sub-groups by 100 person-years of follow-up (100 py). The predictive factors were determined through Kaplan-Meier curves and a Cox regression. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated.ResultsA total of 2,377 prisoners were included with a median follow-up time of 1,540.9 days per patient. Among the total population, 117 HCV seroconversions were detected (incidence of 1.17/100 py). The incidence was higher between 1992 and 1995 (2.57/100 py), among cases with HIV co-infection (8.34/100 py) and among intravenous drug users (IDU) without methadone treatment (MT) during follow-up (6.66/100 py). The incidence rate of HCV seroconversion among cases with a history of IDU and current MT was 1.35/100 py, which is close to that of the total study population. The following variables had a positive predictive value for HCV infection: IDU (p<0.001; HR = 7,30; CI: 4.83–11.04), Spanish ethnicity (p = 0.009; HR = 2,03; CI: 1.93–3.44) and HIV infection (p = 0.015; HR = 1.97; CI: 1.14–3.39).ConclusionThe incidence of HCV infection among prisoners was higher during the first part of the study and among IDU during the entire study period. Preventative programs should be directed toward this sub-group of the prison population.

Ongoing incident hepatitis C virus infection among people with a history of injecting drug use in an Australian prison setting, 2005‐2014: The HITS‐p study

“…The incidence is also within the confidence intervals of the estimate 7.9/100 person‐years (4.9‐12.7) reported in a community‐based cohort of PWID at risk of HCV (HITS‐c), which ran between 2008 and 2011 in Sydney, NSW . The incidence among the continually imprisoned population reported here is similar to other studies of HCV incidence in prison PWID populations . The higher incidence observed among the overall population may be explained by a higher incidence in the period immediately following release from prison.…”

Incidence and correlates of hepatitis C virus infection in a large cohort of prisoners who have injected drugs

“…The crude incidence rate reported here is not directly comparable to other cohorts, as the retrospective component of this study meant that the majority of follow-up time preceded incarceration. The rate of seroconversion in the community after release among those with a history of IDU was similar to that reported in two comparable Australian cohorts of ex-prisoners [14, 29], and in a cohort of PWID continuously incarcerated in a Spanish prison with a needle and syringe exchange program [13]. However, it was substantially lower than rates recorded among continuously incarcerated PWID in New South Wales, where needle and syringe exchange programs are not available [5, 15].…”

“…Comparable prevalence estimates have been observed in prisoners who have injected drugs in Scotland, Spain, and the United States [6, 12, 13]. Seroconversion among HCV-naïve prisoners who inject drugs has been observed at rates between 5 and 34 cases per 100 person-years [8, 9, 14], with the highest rates recorded among those continuously incarcerated [5, 15].…”

Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

“…In Spanish prisons, PWID experience five-fold lower incidence if on OST(13). Similarly, after introducing prison OST in Scotland, evidence suggests HCV incidence amongst incarcerated PWID reduced(9, 14), and is now lower than amongst community PWID(15).…”