Antonio Cuadrado1,1, Susana Llerena1,1, Carmen Cobo1, José Ramón Pallás1, Miguel Mateo1, Joaquin Cabezas1,1, José Ignacio Fortea1,1, Silvia Alvarez1,1, Raúl Pellón1, Juan Crespo1, Santiago Echevarría1,1, Rosa Ayesa1,1, Esther Setién1,1, Marcos Lopez-Hoyos1, Benedicto Crespo-Facorro1,1, Jesus Agüero1, Natalia Chueca1, Federico Garcia1, Jose Luis Calleja1, Javier Crespo1,1. 1. Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.
Abstract
OBJECTIVES: Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Our aim was to create a permanent program of HCV elimination in a prison based on a "test and treat" strategy. METHODS: This open-label clinical trial was conducted in the Spanish prison "El Dueso" between May 2016 and July 2017. Viremic patients were treated with a ledipasvir-sofosbuvir regimen (8-12 weeks) according to the 2015 Spanish Guidelines. A teleconsultation program was established to follow-up patients from the hospital. Non-responders were submitted for a phylogenetic analysis and offered retreatment. An evaluation of new cases of HCV infection was performed every 6 months and upon release in all inmates. RESULTS: 847 (99.5%) inmates accepted to participate. HCV antibodies were present in 110 (13.0%) and 86 (10.2%) had detectable viremia. Most of them were genotype 1 or 3 (82.6%) and had <F2 fibrosis (52.2%). Treatment was started in the 69 inmates whose stay in prison was longer than 30 days. Sustained virological response was achieved in 64 out of 66 patients (96.9%), three of whom were successfully rescued with a salvage regimen after treatment failure. Two patients were lost to follow-up and three are currently on treatment without viremia. As a result, by July 2017 none of the 409 imprisoned was viremic, and neither reinfections nor de novo infections were detected. CONCLUSIONS: A sustained "test-and-treat" strategy against HCV in prisons is feasible and beneficial. Spreading this strategy should entail a public health impact.
OBJECTIVES: Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Our aim was to create a permanent program of HCV elimination in a prison based on a "test and treat" strategy. METHODS: This open-label clinical trial was conducted in the Spanish prison "El Dueso" between May 2016 and July 2017. Viremic patients were treated with a ledipasvir-sofosbuvir regimen (8-12 weeks) according to the 2015 Spanish Guidelines. A teleconsultation program was established to follow-up patients from the hospital. Non-responders were submitted for a phylogenetic analysis and offered retreatment. An evaluation of new cases of HCV infection was performed every 6 months and upon release in all inmates. RESULTS: 847 (99.5%) inmates accepted to participate. HCV antibodies were present in 110 (13.0%) and 86 (10.2%) had detectable viremia. Most of them were genotype 1 or 3 (82.6%) and had <F2 fibrosis (52.2%). Treatment was started in the 69 inmates whose stay in prison was longer than 30 days. Sustained virological response was achieved in 64 out of 66 patients (96.9%), three of whom were successfully rescued with a salvage regimen after treatment failure. Two patients were lost to follow-up and three are currently on treatment without viremia. As a result, by July 2017 none of the 409 imprisoned was viremic, and neither reinfections nor de novo infections were detected. CONCLUSIONS: A sustained "test-and-treat" strategy against HCV in prisons is feasible and beneficial. Spreading this strategy should entail a public health impact.
Authors: Ozden O Dalgic; Sumeyye Samur; Anne C Spaulding; Susana Llerena; Carmen Cobo; Turgay Ayer; Mark S Roberts; Javier Crespo; Jagpreet Chhatwal Journal: Sci Rep Date: 2019-11-14 Impact factor: 4.379