Treatment of chronic hepatitis C virus in the virginia department of corrections: can compliance overcome racial differences to response?

OBJECTIVE: Chronic hepatitis C virus (HCV) is common in the correctional setting and there are few data on the use of interferon (IFN)/ribavirin(RVN) combination therapy in this population. Given the high proportion of African Americans (AA) in correctional facilities, which may be associated with reduced response rates, the correctional setting allows a unique opportunity to compare the response rates of AA to Caucasians (CA). The present study describes our experience of treating HCV in the inmate population of the Virginia Department of Corrections.
METHODS: Of the 119 inmates evaluated between 1998 and 2000, a retrospective analysis of 59 consecutive inmates (mean age 41, 83% male, 55% CA, 73% genotype (GT)1, and 41% with advanced fibrosis) who underwent HCV therapy with IFN a-2b (3 MU TIW) and RVN (1,000-1,200 mg/d) under direct observation was performed. Patients were followed by telemedicine and the primary endpoint was sustained virologic response (SVR) defined as an undetectable HCV RNA at least 24 wk after completion of therapy.
RESULTS: All but one patient completed at least 12 wk of therapy and no patient required dose reduction. By wk 24, 34 inmates (58%) responded (negative HCV RNA) which was higher in CA compared to AA (70%vs 40%; p= 0.037). Although overall SVR was higher in CA compared to AA (41%vs 28%; p= ns), we observed no difference in SVR when comparing only GT 1 CA to AA (33%vs 29%).
CONCLUSIONS: HCV can be effectively treated in the correctional setting with response rates similar to, if not better than the published literature. In this controlled setting of direct observational therapy, we observed similar SVR in CA and AA.