Emanuele Pontali1, Vito Fiore2, Anna Maria Ialungo3, Roberto Ranieri4, Oscar Mollaretti5, Giorgio Barbarini6, Daniele Marri7, Tullio Prestileo8, Serena Dell'Isola3, Elena Rastrelli3, Guido Leo5, Giulio Starnini3, Sergio Babudieri9, Giordano Madeddu2. 1. Infectious Disease Unit, Galliera Hospital, Genoa, Italy. 2. Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy. 3. Medicina Protetta-Unit of Infectious Diseases, Belcolle Hospital, Viterbo, Italy. 4. Penitentiary Infectious Diseases Unit, A.O. Santi Paolo e Carlo, University of Milan, Milan, Italy. 5. Infectious Disease Unit, Ospedale Amedeo di Savoia, Turin, Italy. 6. 2nd Division of Infectious Diseases, Policlinico San Matteo Hospital, Pavia, Italy. 7. Infectious Diseases Unit, A.O. Santa Maria alle Scotte, Siena, Italy. 8. ARNAS, Ospedale Civico-Benfratelli Palermo, Palermo, Italy. 9. Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy. Electronic address: babuder@uniss.it.
Abstract
BACKGROUND: People who are incarcerated have a significantly higher prevalence of HCV infection than the general population. Given their high-risk behavior, they represent a reservoir of HCV infection for the whole community. METHODS: We evaluated all HCV-infected people who were incarcerated in 25 Italian prisons starting direct-acting antivirals (DAAs) treatment between May 2015 and October 2016. We collected information on demographic characteristics, liver disease, HCV-related aspects, anti-HCV treatment, HIV or HBV co-infection. RESULTS: We enrolled 142 incarcerated people treated with DAAs. They were mostly Italians (93.7%) and males (98.6%). Median age was 50 years and 108/142 (76.1%) were cirrhotic patients. Prevalent genotypes were 1a (35.9%) and 3 (35.9%). Two patients were HBV co-infected, twenty-one patients (14.8%) were HIV co-infected and almost all (95.2%) received antiretroviral therapy. 118/142 (83.1%) DAAs-based regimens included sofosbuvir. Treatment completion rate was 94.4%. There were eight (5.6%) discontinuations, one (0.7%) due to an adverse reaction, one due to death (0.7%) and six (5.6%) due to release from prison. SVR12 was achieved in 90.8%. Four patients relapsed but no breakthrough occurred. CONCLUSIONS: Our study shows that in Italian penitentiary settings DAAs treatment is feasible and effective. This intervention is crucial for reducing HCV circulation with possible benefits to the general population.
BACKGROUND:People who are incarcerated have a significantly higher prevalence of HCV infection than the general population. Given their high-risk behavior, they represent a reservoir of HCV infection for the whole community. METHODS: We evaluated all HCV-infectedpeople who were incarcerated in 25 Italian prisons starting direct-acting antivirals (DAAs) treatment between May 2015 and October 2016. We collected information on demographic characteristics, liver disease, HCV-related aspects, anti-HCV treatment, HIV or HBV co-infection. RESULTS: We enrolled 142 incarcerated people treated with DAAs. They were mostly Italians (93.7%) and males (98.6%). Median age was 50 years and 108/142 (76.1%) were cirrhotic patients. Prevalent genotypes were 1a (35.9%) and 3 (35.9%). Two patients were HBV co-infected, twenty-one patients (14.8%) were HIV co-infected and almost all (95.2%) received antiretroviral therapy. 118/142 (83.1%) DAAs-based regimens included sofosbuvir. Treatment completion rate was 94.4%. There were eight (5.6%) discontinuations, one (0.7%) due to an adverse reaction, one due to death (0.7%) and six (5.6%) due to release from prison. SVR12 was achieved in 90.8%. Four patients relapsed but no breakthrough occurred. CONCLUSIONS: Our study shows that in Italian penitentiary settings DAAs treatment is feasible and effective. This intervention is crucial for reducing HCV circulation with possible benefits to the general population.
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