title: Acute hepatitis C virus infection in incarcerated injection drug users.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention has emphasized the need for interventional programs regarding hepatitis C virus (HCV) infection for injection drug users, the group of persons who are at highest risk of acquiring acute infection.
  
  
  METHODS
  We designed a pilot study to assess the feasibility of identifying injection drug users with acute HCV infection in correctional and detoxification facilities. On-site medical providers were educated regarding risk factors and signs and symptoms of infection and were instructed to refer all patients with hepatitis to our specialty clinic.
  
  
  RESULTS
  Over a 30-month period, 21 patients received a diagnosis of acute hepatitis C, 3 received a diagnosis of hepatitis B, and 1 received a diagnosis of hepatitis A. Of the 21 patients with acute hepatitis C, 19 were identified in the prison setting shortly after incarceration. Of the 17 patients who were observed serially (mean duration of observation, 6.3 months), 8 had spontaneous virologic clearance. Early therapy with pegylated interferon was initiated for 5 patients with persistent viremia and led to a sustained virologic response in 2 individuals. All patients agreed to undergo human immunodeficiency virus counseling and testing, as well as to receive immunization for hepatitis A and B.
  
  
  CONCLUSIONS
  Incarceration presents a unique opportunity to identify injection drug users with acute HCV infection, to initiate counseling regarding other bloodborne pathogens, and to facilitate immunizations and HCV treatment.
authors.affiliation: Lemuel Shattuck Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. bmcgovern@tufts-nemc.org
authors.forename: Barbara H
authors.initials: BH
authors.lastname: McGovern
authors.forename: Alysse
authors.initials: A
authors.lastname: Wurcel
authors.forename: Arthur Y
authors.initials: AY
authors.lastname: Kim
authors.forename: Julian
authors.initials: J
authors.lastname: Schulze zur Wiesch
authors.forename: Ioana
authors.initials: I
authors.lastname: Bica
authors.forename: M Tauheed
authors.initials: MT
authors.lastname: Zaman
authors.forename: Joerg
authors.initials: J
authors.lastname: Timm
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Walker
authors.forename: Georg M
authors.initials: GM
authors.lastname: Lauer
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D010865:Pilot Projects; D011329:Prisoners / Q000706:statistics & numerical data; D012367:RNA, Viral / Q000097:blood; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology; D019562:Viral Load; D014766:Viremia
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral