Treatment for Hepatitis C Virus Infection among Inmates

What is the problem and what is known about it so far?

Hepatitis C virus (HCV) is the most common bloodborne virus in the United States. In some people, it can cause chronic hepatitis (persistent inflammation of the liver), cirrhosis (permanent scarring of the liver), and liver failure. Chronic HCV infection also increases risk for liver cancer. Strong antiviral drugs given for long periods (6 to 12 months) can make HCV disappear. These drugs are difficult to take and have many side effects. Doctors usually won't give them to people who drink too much, “shoot up” drugs, have severe liver disease or other serious medical problems, are pregnant or unwilling to practice contraception, or have severe psychiatric problems.

Most often, people get HCV from sharing contaminated needles with persons who are already infected. The virus is particularly common in inmates, primarily because many inmates have histories of drug abuse. Each year, nearly one third of all Americans who are infected with the virus are in prison. Most inmates do not get treated, even though some are in prison for prolonged periods. In fact, evidence on treatment of inmates with HCV infection is sparse.

Why did the researchers do this particular study?

To describe treatment and outcomes of chronic HCV infection in individuals who are in prison for a prolonged period.

Who was studied?

93 HCV-infected inmates with sentences of 15 months or greater.

How was the study done?

The researchers reviewed medical records of inmates who had been housed at correctional facilities in the Rhode Island Department of Corrections between 1997 and 2001. During this time, six doctors identified 93 individuals with chronic HCV infection and prolonged sentences. Three of the individuals were not given treatment because of unstable psychiatric disease. The researchers describe the treatment course and outcomes of the remaining 90 HCV-infected inmates who were treated with antiviral therapy.

What did the researchers find?

Ten inmates discontinued treatment within 6 months because of side effects. One died of liver failure. Fifty of the 79 inmates who received antiviral therapy for at least 6 months had no evidence of virus in their blood at 6 months. Thirty-four had blood tests for the virus 6 months after completing therapy. Of these inmates, 26 had no evidence of virus.

What were the limitations of the study?

The study took place in correctional facilities in one state, Rhode Island. We do not know whether inmates of other correctional facilities receive similar treatment or have similar outcomes.

What are the implications of the study?

Antiviral therapy for chronic HCV infection may be feasible in correctional settings, particularly for those inmates with addiction or mental illness, but costs and long-term clinical outcomes are unknown.