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Treatment of Chronic Hepatitis C in a State Correctional Facility
- Scott Allen, MD;
- Anne Spaulding, MD; and
- Josiah D. Rich, MD, MPH
- From Rhode Island Department of Corrections, Cranston, RI 02920; Centers for Disease Control and Prevention, Atlanta, GA 30333; and Miriam Hospital, Providence, RI 02906.
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IN RESPONSE:
We published our experience with the treatment of incarcerated persons with hepatitis C in part to highlight the fact that such a large proportion of Americans with hepatitis C pass through a correctional facility each year. Since submission of our report, Hammett and colleagues (1) published a detailed explanation of how they calculated that one third of all Americans with hepatitis C are among the 7.75 million individuals who are released from correctional facilities annually. Others (2) have reaffirmed this estimate. The problems associated with the management of hepatitis C in prisons are daunting, and as a result the Centers for Disease Control and Prevention, the National Institutes of Health, the Society of Correctional Physicians, and the University of Texas Medical Branch recently sponsored a national conference on the topic (3).
We reported a sustained viral response in 26 of 65 patients who completed treatment and had data available 6 months after treatment. Most of those “lost to follow-up” did, in fact, complete the treatment course, but end point data were not available at the time of publication. We included a figure showing the outcomes of all patients found eligible for treatment so that readers could perform their own analyses, such as calculating the response based on the intention-to-treat principle. We agree with Dr. Bernstein that the sustained viral response calculated by intention-to-treat is 29%. It is often difficult to replicate results from pharmaceutical trials in clinical practice. In this retrospective case series, we did not find a response equivalent to that found in enrollees of the initial clinical trials. However, our data, like those from the Virginia Department of Corrections, show that treating hepatitis C in prisoners is feasible (4). The results illustrate that our patients are not biologically different from nonincarcerated patients and that many respond in a setting with enforced sobriety and a highly ordered lifestyle.
Scott Allen, MD
Rhode Island Department of Corrections; Cranston, RI 02920
Anne Spaulding, MD
Centers for Disease Control and Prevention; Atlanta, GA 30333
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
