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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

    

http://www.hivcorrections.org/archives/july99/overlooked.html

 

Hepatitis B (HBV) - Overlooked and Under-treated

The prevalence of chronic HBV (HbSAg positive patients) may be lower than Hepatitis C Virus infection in correctional settings, but it is still a threat. In fact, HbSAg positivity rates (up to 47%) are considerably higher than in non-incarcerated populations (5%)(25).

Vaccination and Screening for HBV

Prisons are an ideal setting for HBV vaccination, although only a few facilities have adopted CDC guidelines recommending all inmates and exposed personnel receive the HBCV vaccine. The CDC has also recommended HbSAg screening for all pregnant women, and vaccination is recommended for the household and sexual contacts of HbSAg carriers (26). Correctional facilities can obtain HBV vaccine for free for inmate patients up until their 19th birthday under a federal program, Vaccines for Children. Accessibility may differ in each state but providers can check with local departments of health, which may be willing to consider cost sharing for HBV vaccination for older inmates, depending on the region’s incidence of HBV infection. HBV vaccination has been adopted in some correctional facilities due to the high rate of infection among inmates returning to correctional facilities.  In Rhode Island, incidence of new HBV infection in recidivist women has been demonstrated to be high: 12 per 100 person years. This year, RI DOC began vaccinating inmates less than 19 years old (27). HBV vaccination is less effective in patients who already have HIV infection, thus boosters or higher doses may be needed (26). 

    

Treatment Options for HBV

Interferon at 5 million units subcutaneously for 16 weeks was the first treatment for chronic HBV infection. New agents for HBV, including lamivudine (3TC), adefovir (ADV) and famciclovir (Famvir) are in the process of being evaluated. Each patient should be evaluated for treatment and decisions about treatment should be made on an individual basis. 

Treatment of HBV in the Presence of HIV Co-infection

HIV may lessen the liver damage in the HIV/HBV infected patient and treatment could be less of an issue than with Hepatitis C Virus/HIV co-infection. If, in the future, life expectancy for HIV increases further, even moderate liver damage in HIV/HBV co-infected patient may need to be addressed, especially if HBV treatment improves. Whether sequential or combination therapy is optimal is unclear. Any liver damage at all may be important if it will compromise tolerance of anti-retroviral therapy. 

    

Contributors include:
HEPP Staff and Rob Lyerla, PhD, epidemiologist in the Hepatitis Branch, National Center for Infectious Diseases, CDC.