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| |  Reinfection Common Following Curative Hepatitis C Virus Treatment Among Canadian Prisoners: Presented at ICAAC By Ed Susman SAN FRANCISCO -- September 14, 2009 -- Researchers said that treatment of hepatitis C virus (HCV) infection in prisons -- a disease that may infect more than 25% of the incarcerated population -- can achieve virologic cure, but relapse rates are high. “Most of the prisoners in Canadian Federal correctional institutions are infected with the hepatitis C Virus through intravenous drug use,” said John Farley, MD, private practice, Vancouver, British Columbia, during a poster presentation on September 12 at the 49th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). “Treatment of hepatitis C virus in injecting drug users among inmates of correctional institutions is feasible and effective; however, in this 4-year follow up of those successfully treated between 2002 and 2009, we demonstrate that reinfection is an important occurrence and consideration,” said Dr. Farley. “We feel more must be done to educate the public about the possibility of reinfection,” he said. “We recommend pretreatment counselling as well as regular follow-up and retesting after successfully treating hepatitis C virus infection in drug users in and out of correctional institutions. Harm reduction strategies should also be continually reinforced. Otherwise, reinfections may decrease the overall effectiveness of treatment programs.” Dr. Farley said the treatment for the infection involves either a 24- or 48-week course of therapy, with an injection of pegylated interferon once a week and oral ribavirin twice daily. “In this study, a retrospective chart review, we follow up with patients/inmates we successfully treated for hepatitis C virus infection in as well as out of the correctional institutions for at least 4 years,” he explained. “At each follow-up visit, we ask regarding drug use. We also test for hepatitis C virus on average every 6 months. This is the longest follow-up study for inmates receiving treatment for hepatitis C virus we are aware of.” Of the 479 patients (mean age, 38 years; 70% Caucasian) who initiated treatment, 462 were men, 17 were women, 38 were co-infected with HIV, and 9 were co-infected with hepatitis B. Of the patients, 365 admitted using injection drugs; with 82% initiating injecting drug use in community and 18% in prison environments. About 30% of the patients treated admitted using injection drugs while being incarcerated. Other risk factors for acquiring HCV included tattooing, direct blood splash from fight, sexual contacts, and blood transfusion. After treatment initiation, 97 patients were lost to follow-up. Treatment was discontinued in 61 patients because of nonresponse and in 14 patients due to adverse side effects. A total of 152 patients achieved a sustained virologic response. The 152 patients who were successfully treated were followed up for a range of 6 months to 4 years, Dr. Farley said. “Of those, 112 were former intravenous drug users and likely acquired the infection through intravenous drugs. We identified 34 injecting drug users patients who became reinfected. The time to reinfection was a mean of 77.7 weeks after the scheduled end of treatment.” “Last year, we reported 15 cases of reinfection; as we continue to monitor, this year we have identified additional new cases indicating that reinfection is likely continuing to occur, and may be going unnoticed,” he said [Presentation title: Treatment of HCV Infection in Intravenous Drug Users in Inmates of Correctional Institutions, Canada: Four Year Follow Up - Significant Likelihood of Reinfection. Abstract H-219]
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