HCV more prevalent in prison vs. general population in Spain

Hepatitis C virus infection is 15 times more prevalent among inmates at a prison in the Northern region of Spain compared with the general population, per recent data presented at the 2016 EASL Special Conference: New Perspectives in Hepatitis C Virus Infection.

“This is the first ever project worldwide whose aim is to eliminate HCV in a controlled environment, such as a prison,” Susana Llerena Santiago, MD, of the Servicio Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, told HCV Next. “An elimination program of this nature is intended as a pilot experience that could be extended to other prisons.”

In the trial known as the JAILFREE-C study, Llerena and colleagues performed a systematic screening for HCV infection related to blood-borne viruses and sought to evaluate the safety and efficacy of Harvoni (ledipasvir/sofosbuvir, Gilead Sciences) among inmates at the long-stay prison known as El Dueso. The study was initiated earlier this year and to date, 436 inmates were included to be fully tested for blood-borne viruses. All new entries into the prison will be tested immediately and initiated on treatment. Full results, including SVR12 rates and remaining variables, will be available later this year.

At baseline, the inmates were tested for infection; those with infection were treated and then followed for 30 months. Of these inmates, 98% were men and the median age was 59 years. Sixteen percent of the inmates were anti-HCV positive (n = 70), of which 74% were HCV RNA-positive (n = 52). The most common HCV genotype was genotype 3 (56%) followed by genotype 1 (36%) and genotype 4 (8%).

Three patients with viremia were treated with Harvoni with or without ribavirin for 8 weeks. These patients achieved end-of-treatment response.

Baseline NS5a RAS was found in 19% of patients and overall more common in patients with HCV genotype 3 (36%).

Viral diversity of the HVR1 region was high, regardless of HCV genotype.

No serious adverse events were observed or reported and no patient discontinued treatment due to an adverse event.

“In this Spanish prison, the HCV prevalence is 15 times the described in the general population, showing a different profile of HCV genotypes and a high viral diversity of HVR1,” the researchers wrote.

In a separate study, Llerena and colleagues investigated how effective a telecommunication program between the El Dueso prison and Hospital Universitario Marqués de Valdecilla in Spain would be for monitoring anti-HCV treatment in inmates with HCV. This program was initiated in early 2016 and established via the use of Reunete-Red SARA, a video collaboration tool, per the abstract.

“The Reunete-Red SARA is available for all administrations in Spain,” Llerena said. “It is a trafficking encryption and early-warning system to survey incidents.”

During the program, inmates would answer a series of questions to determine if the tool was useful for monitoring purposes, such as were they able to hear the doctor through the speakers, were they comfortable speaking to the doctor through this medium, among others.

At the time of the study’s presentation, 85 teleconsultations were performed in 100% of HCV-treated inmates. All patients completed the questionnaire.

From the questionnaire results, researchers found the audio channels and video teleconsultation questions yielded satisfactory mean scores, patients reported that they could explain themselves clearly and did understand instructions by the doctor. The researchers noted that some inmates were nervous using this medium. However, this did not interfere with the success of the session and throughout the consultation, the patients were more relaxed.

“The acceptation of the inmate patients is quite well,” Llerena said. – by Melinda Stevens

Reference:

Llerena S, et al. Abstracts #138 and #186. Presented at: EASL Special Conference: New Perspectives in Hepatitis C Virus Infection — The Roadmap for Cure; Sept. 23-24, 2016; Paris.

Disclosure: The study was partially supported by Gilead Sciences.