Dear Corrections Colleagues,

The management of hepatitis C virus (HCV) was one those topics that was guaranteed to get a room full of correctional health care professionals into uproarious debate. Saddled with an astoundingly high prevalence of HCV among inmates, prisons and jails have had to deal with the cruel double edge of HCV treatment; therapy can be curative but is expensive, difficult to tolerate and has disappointingly low rates of success. The limitations of HCV therapy have prompted many correctional systems to withhold or restrict this treatment. Meanwhile, as HCV therapy has become more commonplace in the free world and clinical studies make clear the benefits of treatment, there has been increasing pressure for HCV therapy to be made widely available to prisoners.

In response more correctional systems have come to embrace HCV therapy and have crafted procedures and policies regarding the diagnosis and treatment of this infection. Recently, IDCR reported on the approach taken by prisons in Hawaii and in this issue we provide a report by Dr. David Paar from Texas who describes an innovative strategy that system has developed to identify patients who are most appropriate for HCV therapy while avoiding liver biopsy. In addition, Dr. Lester Wright shines a spotlight on a unique program in New York State to maintain HCV therapy continuity following prison release.

As most of us are well aware, the threat of litigation has motivated the adoption of HCV therapy in correctional systems in no small way. Dr. Joseph Paris, former Medical Director for the Georgia Department of Corrections, in this issue provides his perspective on the legal pitfalls of HCV management in a correctional setting.

Over the past few years more of our inmates have obtained the opportunity to receive treatment for their HCV and different systems, prisons (and even some jails) have devised their own approaches to this infection. Alas, the old HCV in corrections debate has died down only to be replaced by other controversies - many of which you can be assured will be covered in forthcoming issues of IDCR.

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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