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HCV treatment program reduced disease burden in prison
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A treatment program comprising triple therapy with telaprevir, interferon and ribavirin was successful in managing hepatitis C in correctional facilities, which are known to be sites of concentrated infection, according to recent data.
Researchers from the New York Department of Corrections and Community Supervision (NYDOCCS) piloted an HCV treatment program for a group of 50 patients with genotype 1a or1b HCV. Participants were aged 21 to 67 years, HIV-negative, exhibited no uncontrolled mental health issues and had liver fibrosis assessed at METAVIR stage 2 or 3, or stage 4 with compensation. Seventy-six percent were treatment-naive, 14% had relapsed, 8% had achieved partial response to previous treatment, and 2% had failed to respond to any previous treatment. The novel agents evaluated included telaprevir (Incivek, Vertex), pegylated interferon, and ribavirin.
Participants underwent assessment by an infectious disease consultant, received mandatory patient education, and attended primary and specialty follow-up appointments and screening. They were administered antihistamine prophylaxis prior to treatment initiation, and high potency topical steroid creams were also provided to all patients at the start of treatment with instructions to apply twice daily at the sign of a rash. During each weekly interferon injection session, nurses asked patients about rash or itching symptoms. Follow-up visits with the infectious disease consultant were conducted remotely using video and audio equipment.
The researchers found that all of the patients reported symptoms of rash, pruritus or both. Fatigue was reported in 98% of the patients. Anemia was detected in 68% of the participants, leading infectious disease consultants to greatly reduce dosage.
None of the participants required transfusions, and thrombocytopenia was seen in 4%. Neuropsychiatric effects were observed in 64% of the patients. A sustained viral response was achieved in 88% of the patients, and treatment was voluntarily discontinued in 4% of patients.
Although the newest generation of HCV drugs are expensive, the researchers wrote, the use of these various medications in prison settings could have a significant impact in terms of controlling the disease.
“By using the most effective agents available to treat hepatitis C, correctional health care systems can make a unique contribution to public health,” the researchers wrote. “Despite the substantial side effects of the first direct acting agents, the NYDOCCS health care personnel observed and reported a sustained viral response in a select group of patients which exceeded that seen in the drug registration trials.”
Disclosure: The researchers report no relevant financial disclosures.
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