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Hepatitis C Is Common in Prisons, but Treatment Is Rare

August 24, 2015

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Do jail and prison authorities have the right to deny prisoners life-saving medical care simply because of the price tag? People imprisoned in Pennsylvania, Massachusetts and Minnesota are heading to court to find out, with suits focused on access to expensive treatment that can cure hepatitis C. Although prisoner's access to HIV screening and treatment has expanded, hepatitis C treatment remains extremely rare despite high rates of infection among prisoners, many of whom may also be living with HIV.

In early August, attorneys for 61-year-old political prisoner Mumia Abu-Jamal, incarcerated in Pennsylvania, filed a lawsuit challenging the prison authorities' denial of medical care, including treatment for hepatitis C.

In January 2012, Abu-Jamal, who has diabetes, tested positive for the hepatitis C antibody but received no follow-up care. In August 2014, he told medical staff that he was experiencing itching over his entire body. No testing was done to determine his viral load or the possibility that the rash, which was spreading, might be a manifestation of an active hepatitis C infection. The following year, the rash became infected and lesions began to appear. Medical staff noted in his records that these lesions were "too numerous to count." His lower extremities became swollen, his skin took on a dark, scaly appearance and, by February 2015, the rash covered 70% of his body.

On March 30th, Abu-Jamal went into diabetic shock, lost consciousness and was rushed to an outside hospital. He was returned to the prison two days later. In May 2015, Abu-Jamal was again taken to an outside hospital, but was not tested for hepatitis C viral load or genotype. Instead, the discharge report advised the Department of Corrections to order a medical workup since Abu-Jamal might be a suitable candidate for HCV treatment.

It was two more months before a prison doctor told Abu-Jamal that a blood test revealed that he has active hepatitis C. Abu-Jamal was also informed that the Pennsylvania Department of Corrections currently has no protocol for treating hepatitis C. Abu-Jamal's attorney, Bret Grote, is seeking a preliminary injunction ordering tests and treatment because, without them, Abu-Jamal will suffer irreparable damage. In the meantime, supporters are mounting a call-in campaign demanding hepatitis C treatment for Abu-Jamal and others in the Pennsylvania prison system.


Hepatitis C: Serious but Curable

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV) that can cause lasting health damage and death. Although 15% to 25% of people infected have immune systems that can clear the virus, the other 75% to 85% become chronically infected, meaning that the virus evades their immune systems' response. According to the Centers for Disease Control and Prevention (CDC), 60% to 70% of those affected will develop chronic liver disease, 5% to 20% will develop cirrhosis and 1% to 5% will die from liver cancer or cirrhosis caused by HCV. However, unless tested, people may not even know that they are infected; symptoms often take 20 to 30 years to appear.

About three out of every 10 people with HIV are also coinfected with hepatitis C. "HIV and HCV share many characteristics," explains Alan Franciscus, executive director of the Hepatitis C Support Project and author of A Guide to HIV/HCV Coinfection "Both are RNA viruses and both have similar blood-to-blood transmission routes. Because both HIV and HCV are transmitted through the sharing of contaminated needles, many injection drug users acquire both viruses; in some groups of injection drug users, the rate of coinfection may be as high as 90%."

Until recently, HCV treatment consisted of injection-based interferon, which has side effects including flu-like symptoms, depression and chronic fatigue. It also has a low success rate. But in late 2013, the U.S. Food and Drug Administration approved simeprevir (branded as Olysio) and sofosbuvir (branded as Sovaldi), which shorten treatment to 12 weeks, eliminate side effects and clear the virus in 90% to 95% of people. The American Association for the Study of Liver Diseases recommends treatment for all people with chronic hepatitis C infections, except those with a life expectancy of less than a year. But drug companies charge between sixty- to eighty-thousand dollars for a 12-week regimen.

The CDC estimates that one in three of the 2.2 million people in U.S. jails and prisons have hepatitis C, a much higher rate than the 1% to 1.5% infected outside of prison. The Eighth Amendment has been found to give people in jails and prisons a constitutional right to medical care. However, as Abu-Jamal's experience demonstrates, even if medical care is constitutionally guaranteed, it is not always adequate.

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