Some Prisoners Can Achieve Good Hepatitis C Treatment Outcomes, but Response Rates May be Lower than those of Non-inmates

Some prisoners with chronic hepatitis C virus (HCV) infection -- especially genotypes 2 or 3 -- can achieve sustained response using pegylated interferon plus ribavirin, but the likelihood of responding is lower than it is for patients in the outside community, according to a study in the August 2009 Journal of Clinical Gastroenterology.

Hepatitis C is common among prisoners, due in part to transmission via shared needles for injection drug use. It is estimated that about one-third of HCV-infected individuals will spend time in jail or prison in a given year. Some prison authorities, however, have been reluctant to offer treatment for this population.

Kara Chew from the University of California at San Francisco and colleagues reported their experience treating inmates at Rhode Island Department of Corrections facilities using pegylated interferon alfa-2b (PegIntron) plus weight-adjusted ribavirin.

The researchers performed a chart review of all 71 male inmates who started hepatitis C treatment between October 2000 and April 2004. Most (80%) were white and 65% had HCV genotype 1. All of the 9 African-American participants had genotype 1; both genotype 1 and black race are associated with poorer response to interferon-based therapy in most studies. Among the 59 patients who underwent liver biopsies, 41 (69%) had early stage disease.

Results

• The overall sustained virological response (SVR) rate 6 months after completion of therapy was 28%.
• As expected, the SVR rate was lower for patients with genotype 1 than for those with genotypes 2 or 3 (SVR 18% vs 60% and 50%, respectively).
• All these rates were lower than those typically seen in studies of HIV negative, non-incarcerated patients:
• Overall SVR: 28% vs about 50%;
• Genotype 1 SVR: 18% vs about 40%-50%;
• Genotypes 2 or 3 SVR: 50%-60% vs 70%-80%.
• Among inmates with genotype 1, there was no difference in sustained response rates according to race, in contrast to most other studies (18% for whites vs 22% for blacks).
• 11 patients (16%) were lost to follow-up,
• 33 (46%) completed treatment,
• 26 (37%) discontinued therapy due to side effects,
• and 5 (7%) stopped due to poor initial response.

"Acceptable HCV treatment outcomes can be achieved in prisons," the study authors concluded. "Our small study indicates no difference in treatment response by African-American versus white race for genotype 1."

The suboptimal results in this study suggest that incarcerated patients may benefit from assistance staying on therapy, including management of side effects and support to encourage adherence.

Department of Medicine, University of California at San Francisco, San Francisco, CA.

9/11/09

Reference

KW Chew, SA Allen, LE Taylor, and others. Treatment Outcomes With Pegylated Interferon and Ribavirin for Male Prisoners With Chronic Hepatitis C. Journal of Clinical Gastroenterology 43(7): 686-691. August 2009. (Abstract).