Telemedicine HCV Treatment in Department of Corrections Results in High SVR in Era of Direct-acting Antivirals

Taseen A. Syed; Reena Cherian; Shawn Lewis; Richard K. Sterling

Disclosures

J Viral Hepat. 2020;28(1):209-212. 

In This Article

Abstract and Introduction

Abstract

Chronic hepatitis C virus (HCV) is common in the Department of Corrections (DOC). Telemedicine is an effective way to treat HCV. The goal of this report was to demonstrate high SVR rate in DOC patients using telemedicine irrespective of the HCV genotype (GT) and DAAs used. Demographic, clinical and laboratory data were prospectively collected. A total of 870 DOC patients were evaluated and completed HCV therapy June 2015-December 2019 with SVR data were included. The mean age was 50 years, 90% were male, 63% were Caucasian, the majority (79%) had GT 1, 92% were treatment naive, and 80% had advanced fibrosis (FIB-4 ≥ 3.25 and/or transient elastography ≥ 9.5 kPa). The overall SVR was 97% and was similar among all DAAs irrespective of age, sex, race, HIV status, fibrosis level, GT, ribavirin use, prior treatment experience or DAA duration. We conclude that HCV treatment in the DOC through telemedicine is achievable and highly effective with overall SVR 97%, irrespective of the underlying GT or DAA regimen used and can eliminate HCV in this microenvironment and reduce the overall burden of HCV.

Introduction

Chronic hepatitis C virus (HCV) infection rates are high in state and federal correctional facilities (16%-41%).[1] Effective strategies for treatment among those incarcerated are needed since HCV infection can lead to cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC) and thus cause significant morbidity and mortality in inmates.[2] Direct-acting antiviral (DAA) regimens have resulted in high sustained virologic response (SVR) among most if not all HCV-infected compensated patients, regardless of race, presence of advanced fibrosis or human immunodeficiency virus (HIV) coinfection.[3] With the evolving updates of joint American Association for the Study of Liver Diseases and Infectious Diseases Society of America (AASLD-IDSA) recommendations and wider availability of DAA regimens, there is further need to document treatment efficacy in infected individuals, especially in the incarcerated population.[4] Telemedicine has been used to overcome the barrier to healthcare access and the need for direct provider-to-patient interaction for HCV treatment. Prison environment in general is often a physical impediment to provision of specialist care. Therefore, use of telemedicine to provide HCV treatment to incarcerated population seems to be an effective method due to high patient satisfaction and physician acceptance due to its efficiency, feasibility and wide availability.[5]

We report our clinical experience in the evaluation and treatment of HCV-infected individuals in Virginia Department of Corrections (DOC) through telemedicine with a variety of DAAs for different genotypes (GT).

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