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Heroin Addiction and Related Clinical Problems: 2006, 08, 2 (pages: 47 - 49)

Treatment for hepatitis C in jailhouses is doable and successful: definitive data of first national French study (POPHEC)

Remy A. J., Serraf L., Galinier A., Hedouin V., Gosset D., Wagner P.

Summary: Background: A French survey of 85 jailhouses in 2000 yielded disappointing results on the diagnosis and treatment of hepatitis C (HCV) in inmates: serology was available for 2/3 of the patients, but only 36% had undergone liver biopsies (LB) and only 4% had been treated. LB access was identified as an obstacle to therapy. This prospective study (POPHEC) was designed to increase treatment access in this population. Methods: 37 medical units in French jailhouses participated. Patients were all to be treated with a combination of pegylated interferon alpha 2b and ribavirin. LBs were optional. Biochemical, virological and clinical data were collected. Therapy and data collection continued for patients who were transferred. In cases where final data were unavailable, patients were classified as non-responders. Results: As of 1st June 2004, 200 patients were analysed: 94% were male, mean age 37 years, contamination route IVDU in 78%, transfusion in 3%. The genotype was 1a, 1b, 3a and 4 in 28%, 11%, 36% and 7%, respectively; 12% were also infected with HIV; 37% were treated with methadone or buprenorphine. The average viral load was 1227689 IU/mL; 33% had LB before treatment, with a mean Metavir score of A1.8 F1.73. The mean treatment duration ranged between 4 months in patients with early termination due to non-medical reasons and 7 months for patients who completed therapy; 95 patients (47.5%) experienced a complete sustained response). Conclusion: treatment for HCV in jailhouses is feasible and sucessful; the limitations placed on indications for LBs, as recommended by the 2002 French consensus conference, apply specifically to the inmate population and facilitate access to HCV therapy, besides helping initiatives such as POPHEC