An estimated two million Americans are infected with hepatitis C, which now accounts for more than 40% of chronic liver disease in the U.S. and causes about 10,000 deaths per year. In jails and prisons, the prevalence of HCV is ten to twenty times higher than that in the free population, and an estimated one-third of all HCV-infected Americans have spent time in jail or prison. By all measures, correctional health care systems are bearing the brunt of the responsibility for responding to this nation's HCV epidemic. The financial aspects of this responsibility are overwhelming. Many correctional departments are faced with difficult decisions concerning allocation of inadequate resources.
Essential components of a comprehensive response to HCV should include:
Some correctional health care programs have attempted to implement targeted HCV testing based upon risk assessment histories. As this month's HCV 101 demonstrates, virtually all inmates fall into a risk group for which HCV testing would be recommended (individuals with abnormal alanine aminotransferase levels, those who have had more than 10 lifetime sex partners, those who have had a history of a sexually transmitted disease, injection-drug users, and men who have had sex with men.) Therefore, rather than attempting to coordinate risk-based screening, it is likely to be more cost-effective to simply offer testing for HAV, HBV, and HCV to all individuals whose serostatus is unknown.
This month, Drs. Brian L. Pearlman and Joseph E. Paris provide a review of current HCV issues including early viral response, management of those with persistently normal transaminases, the role of the liver biopsy, management of HIV co-infected persons, and treatment outcomes based upon racial background. In this month's spotlight, Dr. David Thomas reviews HCV treatment from public health, legal, ethical, risk/benefit, and patient responsibility perspectives.
In an effort to reflect the broad spectrum of infectious diseases that impact the correctional setting, HEPP Report will soon be changing its name to IDCR: Infectious Diseases in Corrections Report. The print and online versions will continue to provide the same up-to-date information but in a more reader- and user-friendly format. We encourage our readers to share their opinions on both the content and new appearance of the newsletter.
Joe Bick, M.D.