Division of Infectious Diseases, Boston, MA; Harvard University Center for AIDS Research, Boston, MA USA. Akim1@partners.org.
Acute hepatitis C virus (HCV) infection is underdiagnosed because most patients are asymptomatic. The majority of new infections occur among people who inject drugs (PWID), many of whom have a history of incarceration. In a previous pilot study, we identified symptomatic HCV cases, mainly among Caucasian inmates. We designed a cross-sectional study to evaluate whether risk factor-based screening of newly incarcerated inmates would enhance identification of asymptomatic acute HCV infection and elucidate any demographic shifts in HCV acquisition. From October 2006-March 2008, 6,342 inmates underwent health assessments and 3470 inmates (55%) were screened. The racial distribution was as follows: African-American 24.0%, Caucasian 49.5%, Hispanic 22.2%. One hundred seventy-one inmates (4.9%) were classified as high-risk. After further evaluation, 35 (20.5%) were diagnosed with acute HCV with a mean age of 29 years; 62.9% were female and 91% were Caucasian. No African-Americans were diagnosed with acute HCV. Our case-finding rate was 1.9 patients/month nearly a three-fold increase compared to our historical control period with a higher proportion of asymptomatic cases. We estimate a prevalence of ∼1.0% [95% CI 0.7%-1.4%] of acute HCV infections among newly incarcerated inmates. Conclusions: Within the correctional system, systematic screening based on risk factors successfully identifies acute HCV infection among PWID, including asymptomatic patients. Our data also reflect changing nationwide patterns of injection drug use that vary by age, ethnicity, and race, leading to a marked reduction of acute HCV infections among African-Americans as compared to non-Hispanic whites. The nationwide implementation of this simple low-cost strategy in prison-based settings could identify more than 7,000 acute HCV infections among PWID and provide insight into changing epidemiologic trends and facilitate appropriate therapeutic and preventive interventions.