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33% of HCV positive are in prisons, jails
Publication: Corrections Digest
Date: Friday, October 25 2002


An estimated one-third of the nearly four million people with documented hepatitis C pass through a correctional institution in a given year, putting corrections at the very epicenter of the nation's HCV epidemic.
Unlike HIV, the HCV prevalence rate is uniformly high throughout the United States, particularly among injection drug users. and others who are more likely to spend time in prisons and jails.
Consequently, correctional institutions are shouldering a disproportionate share of the nation's HCV caseload.
The New York and Pennsylvania prison systems, for example, report HCV prevalence rates of 13 and 23 percent respectively based on random sero-prevelence studies.
In Virginia, the HCV rate among the state's prison population stands at 39 percent; in Maryland, its 38 percent and in Texas, the rate is 28.6 percent.
In California, HCV prevalence estimates vary from 35 to 41 percent and even in states such as Colorado and Arizona where the HIV infection rates are low, prison systems report HCV prevalence rates of 12 and 22 percent each.
"There really are no other health care systems in this country that are faced with the sheer scope of numbers of patients with hepatitis C that we have in corrections," said Dr. Newton Kendig, medical director for the Federal Bureau of Prisons.
Unlike HIV, there is no federally endorsed standard of care for HCV, creating a gray area when it comes to offering and providing HCV treatments.
The federally endorsed HIV treatment
guidelines, for example, recommend highly active antiretroviral therapy (HAART) when a person's CD-4 count falls to 350; they strongly urge the initiation of HAART before a person's CD-4 cell count falls below 200.
If left untreated, the person with HIV disease will progress to AIDS and eventually die in most instances, a scenario that bolsters the guideline recommendations, making them clear cut and uniform, even unassailable in some respects.
The same prognosis does not apply to HCV. HCV, unlike HIV, is not uniformly fatal without treatment; at the same time, it is a slow moving disease that takes years, even decades, for overt symptoms to appear.
Perhaps most importantly, HCV is a variable disease.
Physicians cannot ascertain who is going to progress and who is not going to progress to cirrhosis, making decisions about who to treat and when to treat highly subjective and open to interpretation in many cases. A general consensus statement will not be able to resolve that issue at the current level of science.