Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison,WI.
The prevalence of chronic hepatitis C virus (HCV) infection among incarcerated individuals in the United States is estimated to be between 12-31%. HCV treatment during incarceration is an attractive option due to improved access to healthcare and directly observed therapy. We compared incarcerated and non-incarcerated HCV-infected patients evaluated for treatment at a single academic center between January 1, 2002 and December 31, 2007. During this period, 521 non-incarcerated and 388 incarcerated patients were evaluated for HCV treatment. 319 (61.2%) non-incarcerated patients and 234 (60.3%) incarcerated patients underwent treatment with pegylated interferon and ribavirin. Incarcerated patients were more likely to be male, African-American race, and have a history of alcohol or intravenous drug use. Treated incarcerated patients were less likely to have genotype 1 virus and were less likely to have undergone previous treatment. There was a similar prevalence of co-infection with HIV in both groups. A sustained viral response (SVR) was achieved in 97 (42.9%) incarcerated patients compared to 115 (38.0%) non-incarcerated patients (p=0.304). Both groups had a similar proportion of patients that completed a full treatment course. Stepwise logistic regression was conducted and the final model included full treatment course, non-genotype 1 virus, younger age at treatment start, and negative HIV status. Incarceration status was not a significant predictor when added to this model (p = 0.075). Conclusion: In a cohort of HCV-infected patients managed in an academic medical center ambulatory clinic, incarcerated patients were as likely to be treated for HCV and as likely to achieve an SVR as non-incarcerated patients.