Acute Hepatitis C Virus Infection in Incarcerated Injection Drug Users

• Published in: Clinical infectious diseases Vol. 42; no. 12; pp. 1663 - 1670
• Main Authors: McGovern, Barbara H., Wurcel, Alysse, Kim, Arthur Y., zur Wiesch, Julian Schulze, Bica, Ioana, Zaman, M. Tauheed, Timm, Joerg, Walker, Bruce D., Lauer, Georg M.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15-06-2006; University of Chicago Press; Oxford University Press
• Subjects: Adult; Antiviral Agents - therapeutic use; Articles and Commentaries; Biological and medical sciences; Correctional institutions; Criminal punishment; Disease control; Drug abuse; Drug addictions; Female; Genotype & phenotype; Hepacivirus; Hepacivirus - genetics; Hepatitis; Hepatitis C; Hepatitis C - complications; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Hepatitis C - prevention & control; HIV; Hospitals; Human immunodeficiency virus; Human viral diseases; Humans; Infections; Infectious diseases; Injections; Interferon; Male; Maximum likelihood method; Medical procedures; Medical sciences; Medical treatment; Middle Aged; Minority & ethnic groups; Needlestick injuries; Patients; Phylogeny; Physical examinations; Pilot Projects; Prevention programs; Prisoners; Prisoners - statistics & numerical data; Public health; Risk factors; RNA; RNA, Viral - blood; Substance abuse treatment; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - epidemiology; Symptoms; Testing; Toxicology; Viral diseases; Viral hepatitis; Viral Load; Viremia; White people; Infection; Human; Drug addiction; Intravenous administration; Viral disease; Acute; Digestive diseases; Hepatic disease; Viral hepatitis C
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/504327

Background. The Centers for Disease Control and Prevention has emphasized the need for interventional programs regarding hepatitis C virus (HCV) infection for injection drug users, the group of persons who are at highest risk of acquiring acute infection. Methods. We designed a pilot study to assess the feasibility of identifying injection drug users with acute HCV infection in correctional and detoxification facilities. On-site medical providers were educated regarding risk factors and signs and symptoms of infection and were instructed to refer all patients with hepatitis to our specialty clinic. Results. Over a 30-month period, 21 patients received a diagnosis of acute hepatitis C, 3 received a diagnosis of hepatitis B, and 1 received a diagnosis of hepatitis A. Of the 21 patients with acute hepatitis C, 19 were identified in the prison setting shortly after incarceration. Of the 17 patients who were observed serially (mean duration of observation, 6.3 months), 8 had spontaneous virologic clearance. Early therapy with pegylated interferon was initiated for 5 patients with persistent viremia and led to a sustained virologic response in 2 individuals. All patients agreed to undergo human immunodeficiency virus counseling and testing, as well as to receive immunization for hepatitis A and B. Conclusions. Incarceration presents a unique opportunity to identify injection drug users with acute HCV infection, to initiate counseling regarding other bloodborne pathogens, and to facilitate immunizations and HCV treatment.