Dear Corrections Colleagues,

At least 3 million people in the United States live with chronic Hepatitis C Virus (HCV) infection and many are involved in the criminal justice system. In several areas of the country, the prevalence of HCV in prisons and jails exceeds 30% and in some prisons almost half of the inmates are reportedly infected. The actual prevalence of HCV among inmates is certainly higher as screening for HCV in correctional facilities is not universal.

The establishment of standards of care for HCV management, which include the use of expensive therapies, has led to an increased demand for HCV treatment among inmates but has strained prison and jail health care budgets. While different facilities have adopted disparate and individualized approaches to the financing of HCV therapy, the medical management of this infection in our correctional system should be much less variable. As detailed in IDCR (October, 2005, July 2005), guidelines for the diagnosis and treatment of HCV have been established and include recommendations made by the National Institutes of Health (NIH) and the American Association for the Study of Liver Disease (AASLD) among others.

However, applying these recommendations to corrections has not always been straightforward and among the arguments for the deferral of HCV therapy during incarceration the cost of treatment is often accompanied by concerns regarding its tolerability. In this issue, Drs. Bauman and DeWitt from the Hawaii Department of Public Safety share their experience in managing the complications of HCV therapy and describe the underpinnings of their impressive rate of HCV treatment completion. Their success should be reassuring to correctional clinicians considering implementing HCV treatment programs. Their report is complemented by a series of insightful case discussions by Dr. Douglas Fish of the Albany Medical College. Later this year, Dr. David Paar will report in IDCR on the evolution of the Texas Department of Corrections' policies on the diagnosis and management of HCV.

The experience of these clinicians and those from other correctional systems make it increasingly difficult to reasonably justify the denial of HCV therapy to inmates who medically qualify for therapy and who will be incarcerated for a sufficient duration of time to receive treatment.

Sincerely,

David A. Wohl, MD
Associate Professor of Medicine
Division of Infectious Diseases
AIDS Clinical Research Unit
University of North Carolina

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