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A Silent Killer Doing Time, Hepatitis C in the Bureau of Prisons: A Drug Utilization Evaluation Study of Anti-Viral Therapy

1 August 2004


There are currently over 175,000 inmates in the custody of the Federal Bureau of Prisons (BOP) serving their sentences in 100 correctional institutions or detention centers throughout the United States. Approximately 10,000 to 11,000 of these inmates are diagnosed with hepatitis C virus (HCV). Since universal screening for hepatitis C virus (HCV) is not performed on all Federal prisoners, it can only be estimated that 10-25% of Federal inmates may be infected with HCV, however some estimates indicate as high as 50-60% are infected within the correctional setting. Correctional health practitioners are faced with the daunting task of identification, treatment and management of this rapidly growing infectious disease problem. HCV is a silent killer that has been termed the 20 year disease owing to its largely asymptomatic presentation over time while insidiously progressing in its pathological hepatocellular destruction and concomitant systematic diseases. Successful treatment within the BOP health care system is dependent on many factors. The BOP uses strict criteria to start HCV treatment. Treatment success in the past has been predicated on the social stability of the inmate populations. It was hoped that sustained viral response rates would reflect this stability. This report will present a treatise on the nature of hepatitis C virus as a disease entity, BOP strategies for management of HCV, a data analysis of the BOP Health Services Drug Utilization Evaluation study concerning treatment outcomes using dual anti-viral therapy, and the latest concepts for successful clinical management and treatment of HCV. The ultimate goal of treatment within the correctional setting is in the release of inmates who have achieved HCV viral load control through treatment and who understand the affect of co-morbidity as related to the disease through life style behavioral controls. Inmates released into the mainstream of America with primary, secondary, and tertiary HCV treatment modalities intact can positively affect the public health model as a whole. It is the desire of this author that the reader gain a clinical perspective that will assist them in approaching, managing and treating HCV in any community setting.


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