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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).
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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).
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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.
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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.
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