Background To eliminate hepatitis C virus (HCV) infection in institutionalised patients it is necessary to reduce the risk of transmission in the general population. There is a high prevalence of HCV infection in the prison population (PP).
Purpose To develop a multidisciplinary programme for the diagnosis and treatment of HCV infection in PP of three prisons and evaluate the effectiveness and safety of treatment for HCV.
Material and methods A multidisciplinary programme (prison physicians, hospital pharmacists and physicians of infectious diseases) from June 2016 to September 2018 was designed. Total PP of three penitentiary centres were included. HCV serology tests were made. PP with HCV +serology were analysed: HCV genotype and hepatic fibrosis stage. Medical assistance and drug dispensing were performed twice a week. At first, HCV-PP with higher hepatic fibrosis stage (F4–F3) were treated. For the past year, all HCV-PP received therapy regardless of hepatic fibrosis stage. The following variables were collected: gender, patient type (naïve/pretreated), HIV coinfection, therapy, withdrawal treatments and HCV recurrence. Effectiveness end points were end of treatment response (EOT) and sustained virologic response at week 12 (SVR12). EOT was determined as undetectable HCV-RNA at treatment completion and SVR12 as undetectable HCV-RNA 12 weeks after the ending of treatment. Security was evaluated based on related adverse effects (AE) and deaths.
Results HCV serology tests of 2068 patients were made: 181 patients were HCV +and treated. Variables data: 125 (69.1%) males, 157 (86.7%) naive, 49 (27.1%) HIV/HCV coinfected. Hepatic fibrosis stages were: 50 (27.6%) F4, 28 (15.5%) F3, 34 (18.8%) F2 and 69 (38.1%) F0–1. HCV genotype: 59 (32.6%) G1a, 33 (18.3%) G1b, two (1.1%) G2, 50 (27.6%) G3, 35 (19.3%) G4 and two (1.1%) G-unclear. The most frequent treatments were: 51 (28,2%) glecaprevir/pibrentasvir, 41 (22.7%) sofosbuvir/velpatasvir, 29 (16%) elbasvir/grazoprevir and 25 (13.8%) sofosbuvir/ledipasvir. One-hundred and eighteen (65.2%) patients were treated for 12 weeks. There were five (2.8%) withdrawal treatments. HCV recurrence: four (2.2%) patients. One-hundred and forty-three completed treatment and 114 had measurable SVR12 at the end of the study: 136/143 (95.1%) achieved EOT and 103/114 (90.4%) SVR12. AE was one (0.5%) hepatic decompensation, which caused death.
Conclusion The multidisciplinary programme diagnosed and treated all PP with HCV infection, although some withdrawal treatments were recorded. EOT and SVR12 were achieved in most patients. An AE leading a death.
References and/or acknowledgements None.
No conflict of interest.