Microelimination of chronic hepatitis C by universal screening plus direct-acting antivirals for incarcerated persons in Taiwan
Journal
Open Forum Infectious Diseases
Journal Volume
7
Journal Issue
8
Date Issued
2020
Author(s)
Abstract
Background. Incarcerated persons are a special population with higher hepatitis C virus (HCV) prevalence and should be prioritized for microelimination. In this study, we investigate the seroprevalence and evaluate the effectiveness and safety of direct-acting antiviral (DAA) therapy in custodial settings. Methods. Incarcerated persons in Yunlin Prison were recruited to receive anti-HCV antibody screening. Patients with positive HCV ribonucleic acid (RNA) were treated with glecaprevir/pibrentasvir (GLE/PIB) in our special chronic hepatitis C (CHC) clinic in prison. The primary endpoint was sustained virologic response at week 12 off therapy (SVR12). Results. A total of 1402 incarcerated persons were invited to anti-HCV screening and 824 (58.7%) accepted. The prevalence of anti-HCV positivity was 33.5% (276 of 824), and the viremic rate (detectable HCV RNA) was 69.2% (191 of 276). According to fibrosis index based on 4 factors, patients with F3 stage were 6 (3.1%), but none met the criteria of F4 stage. However, 6 (3.1%) had liver cirrhosis with splenomegaly, confirmed by findings of ultrasonography. The median log10 HCV RNA level at baseline was 6.235 (2.394-7.403). Genotype (GT) 6 was predominant (39.3%), followed by GT 1a (22.0%) and 1b (14.1%). Mixed GT HCV infection accounted for 3.6% of total infections. In total, 165 patients received GLE/PIB therapy. The overall SVR12 rates were 100%. Conclusions. Direct-acting antiviral therapy is highly effective and safe for incarcerated patients in Taiwan. Our special prison-based CHC clinic, linking universal screening to medical care, can serve as a model for microelimination of HCV in custodial settings. ? The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
SDGs
Other Subjects
alanine aminotransferase; albumin; antivirus agent; aspartate aminotransferase; bilirubin; creatinine; daclatasvir; entecavir; hepatitis B surface antigen; lamivudine; ledipasvir plus sofosbuvir; peginterferon; ribavirin; ritonavir; simeprevir; sofosbuvir; virus RNA; adult; anorexia; antiviral therapy; Article; Child Pugh score; chronic hepatitis C; cohort analysis; drug safety; echography; fatigue; female; genotype; health care system; human; Human immunodeficiency virus; limit of quantitation; liver cirrhosis; major clinical study; male; middle aged; prevalence; prospective study; pruritus; risk factor; seroprevalence; splenomegaly; virus load
Publisher
Oxford University Press
Type
journal article