Implementation of Treating Chronic Hepatitis C in a Correcting Institute by a Hospital-Backup Clinic
Science Journal of Public Health
Volume 6, Issue 1, January 2018, Pages: 21-25
Received: Sep. 5, 2017;
Accepted: Dec. 23, 2017;
Published: Jan. 15, 2018
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Lian-Feng Lin, Department of Gastroenterology, Pingtung Christian Hospital, Pingtung, Taiwan; Department of Nursing, Meiho University, Pingtung, Taiwan
Yi-Chun Chan, Department of Gastroenterology, Pingtung Christian Hospital, Pingtung, Taiwan
Seng Howe Nguang, Department of Gastroenterology, Pingtung Christian Hospital, Pingtung, Taiwan
Background: chronic viral hepatitis C (HCV) is endemic in the correctional facilities due to intravenous drug use (IDU). In Taiwan, the health insurance reimbursed the interferon-based dual therapy for chronic HCV in the correcting institute since Jan 2013. Therefore, this work is to investigate the feasibility and safety of a hospital-backup clinic care to treat HCV with dual therapy in a correcting facility. Pingtung Christian Hospital established regular clinics on weekdays inside this correcting facility, and offered the computer system, physicians, clinical nurses, laboratory and pharmacy. The chronic HCV infected prisoner was cared in a regular hepatitis clinic, the consultation, blood test, serology and virology test, sonogram, interferon injection were implemented in the clinics, but EPO and transfusion was not offered. Prisoners, who had the will and fitted the indication/contra-indication of interferon-based therapy, were enrolled for treatment. The therapy was guided by Taiwan health insurance guideline--- Pegasys 180 mcg/week combined ribavirin 15 mg/kg/day for 6 months if rapid viral response (RVR) achieved, and 12 months if RVR not achieved but early viral response achieved regardless of genotype. From Apr 2013 to Dec 2016, 103 voluntary prisoners, mean 39.3 ± 5.9 years old, all male and IDU, were enrolled for dual therapy. All the treatment-related events were managed inside the facility and the most common side effects of therapy is skin rash with itching in which anti-histamine medication was necessary but did not cause withdrawing. The rapid viral response rate was achieved in 70.9% of treatment inmates, 11 patients withdrew from therapy due to 4 influenza-like side effects, 1insomnia, 1 hyperthyroidism, 1 flared psoriasis, 2 early releases and 2 transferring prison. Among the 92 cases of complete treatment, 8 patients lose SVR follow-up owing to 5 transferring and 3 early releasing. SVR was achieved in 80 patients. The per-protocol and intention-to-treat SVR is 95.2% (80/84) and 82.7% (85/103) respectively. Five patients of the 7 withdrawers achieved SVR in spite of incomplete therapy due to side effect. All of the side effect could be managed in the clinic. In conclusion, this model of hospital back-up clinic to execute interferon-based therapy for chronic HCV infected inmates was feasible and it achieves excellent eradication rate. But early release and transferring prison may interfere the comprehensive treatment and post-treatment following up, the efforts to improve the coordination between correction institutes or community should be made.
Seng Howe Nguang,
Implementation of Treating Chronic Hepatitis C in a Correcting Institute by a Hospital-Backup Clinic, Science Journal of Public Health.
Vol. 6, No. 1,
2018, pp. 21-25.
Chen CH, Yang PM, Huang GT, Lee HS, Sung JL, Sheu JC. Estimation of seroprevalence of hepatitis B virus and hepatitis C virus in Taiwan from a large-scale survey of free hepatitis screening participants. Formosa Med Assoc 2007; 106: 148-55.
Yu ML, Chuang WL, Chen SC, Dai CY, Hou C, Wang JH, et al. Changing prevalence of hepatitis C virus genotypes: molecular epidemiology and clinical implications in the hepatitis C virus hyperendemic areas and a tertiary referral center in Taiwan. J. Med. Virol. 2001; 65: 58-65.
Liu CJ, Chuang WL, Lee CM, Yu ML, Lu SN, Wu SS, et al. Peginterferon Alfa-2a plus ribavirin for the treatment of dual chronic infection with hepatitis B and C viruses. Gastroenterolology 2009; 136: 496-504.
Liu CH, Liu CJ, Lin CL, CC Liang, SJ Hsu, SS Yang, et al. Pegylated interferon-alpha-2a plus ribavirin for treatment-naïve Asian patients with hepatitis C virus genotype 1 infection: a multicenter, randomized controlled trial. Clin. Infect. Dis. 2008: 47; 1260-9.
Yu ML, Dai CY, Huang JF, Chiu CF, Yang YH, Hou NJ, et al. Rapid virological response and treatment duration for chronic hepatitis C genotype 1 patients: a randomized trial. Hepatology 2008; 47: 1884-93.
Yu ML, Dai CY, Huang JF, Hou NJ, Lee LP, Hsieh MY, et al. A randomized study of peginterferon and ribavirin for 16 versus 24 weeks in patients with genotype 2 chronic hepatitis C. Gut 2007; 56: 553-9.
Chang CJ, Lin CH, Lee CT, Chang SJ, Ko YC, Liu HW. Hepatitis C virus infection among short-term intravenous drug users in southern Taiwan. Eur J Epidemiol. 1999; 15: 597-601.
Liao KF, Peng CY, Lai SW, Chang Wl, Hsu NY. Descriptive epidemiology of hepatitis C virs among male heroin abusers in Taiwan. South Med J. 2006; 99: 348-51.
Sieh MH, Tsai JJ, Hsieh My, Huang CF, Yeh ML, Yang JF, et al. Hepatitis C virus infection among injection drug users with and without HIV coinfection. PLoS One. 2014; 9 (4): e94791.
Chew KW, Allen SA, Taylor LE, Rich JD, Feller E. Treatment outcomes with pegylated interferon and ribavirin for male prisoners with chronic hepatitis C. J Clin Gastroenterol 2009; 43: 686-691.
Strock P, Mossong J, Hawotte K, Arendt V. Access to treatment of hepatitis C in prison inmates. Dig Dis Sci 2009; 54: 1325-1330.
Maru DS, Bruce RD, Basu S, Altice FL. Clinical outcomes of hepatitis C treatment in a prison setting: feasibility and effectiveness for challenging treatment populations. Clin Infect Dis 2008; 47: 952-961.
Iacomi F, Iannicelli G, Franceschini A, Migliorisi P, Rosati S, Piselli P, et al. HCV infected prisoners: should they be still considered a difficult to treat population? BMC Infect Dis. 2013 Aug 14; 13: 374.
Chen CH, Sheu JC, Wang JT, Huang GT, Yang PM, Lee HS, et al. Genotypes of hepatitis C virus in chronic liver disease in Taiwan. J Med Virol 1994; 44: 234-6.
Kao JH, Chen PJ, Lai MY, Yang PM, Sheu JC, Wang TH, et al. Genotypes of hepatitis C virus in Taiwan and the progression of liver disease. J Clin Gastroenterol 1995; 21: 233-7.
Lin HH, Kao JH, Mizokami M, SC Huang, PJ Chen, DS Chen, et al. Serotypes, genotypes and levels of hepatitis C viremia in pregnant women in Taiwan. J Formos Med Assoc 1996; 95: 429-34.
Wu JS, Lee HF, Hsiau HL, Lu HY, Chou WH, Lu CF, et al. Genotype distribution of hepatitis C virus infection in Taiwan. J Med Virol 1994; 44: 74-9.
Liu JY, Lin HH, Liu YC, Lee SJ, Chen YL, Hung CC, et al. Extremely high prevalence and genetic diversity of hepatitis C virus infection among HIV-infected injection drug users in Taiwan. Clin Infect Dis. 2008; 46: 1761-8.
McGovern B. A golden opportunity: the treatment of hepatitis C in HIV-infected inmate. J Addit Dis 2008; 27: 69-73.
Vallabhaneni S, Macalino GE, Reinert SE, Schwartzapfel B, Wolf FA, Rich JD. Prisoners favor hepatitis C testing and treatment. Epidemiol Infect 2006; 134: 243-248.
Marco A, Anton JJ, Trujols J, de Juan J, Faraco I, Caylà JA, et al. Personality disorders do not affect treatment outcomes for chronic HCV infection in Spanish prisoners: the Perseo study. BMC Infect Dis. 2015; 15: 355.
Juan JD, De la Hoya PS, Marco A, JJ Anton, I Faraco, C Yllobre, et al. Multicenter study on the discontinuation and efficacy of chronic hepatitis C treatment in the Spanish penitentiary population (EPIBAND study). Eur J Gastroenterol Hepatol. 2014 Oct; 26 (10): 1083-9.