title: High prevalence of late relapse and reinfection in prisoners treated for chronic hepatitis C.
abstract: OBJECTIVE
  Prisoners have a high prevalence of injection drug use (IDU) and chronic hepatitis C (CHC) infection. Treatment of CHC in these patients is effective; however, their long-term outcomes following treatment are unknown. We determined the durability of a sustained virological response (SVR) in prisoners treated for CHC.
  
  
  METHODS
  Patients were treated as part of routine clinical practice with interferon (IFN) and ribavirin. A retrospective review of medical records and a computerized pathology system was performed for clinical and laboratory information.
  
  
  RESULTS
  Seventy-four prisoners (70 males, mean age 34 years, IDU in 55%) were evaluable for a SVR over a 12-year period to December 2008; the mean follow-up period was 1243 days. Genotype 1, 2, 3, and 6 infection was present in 18, three, 38 and three patients, respectively; the genotype was unknown in 12. Three out of 52 biopsied had cirrhosis. Standard IFN was administered to 25 (34%; 11 with ribavirin), and 49 received pegylated IFN and ribavirin; one did not complete treatment, and two had breakthrough relapses. The end-of-treatment response was achieved in 57 and SVR in 53; 14 were non-responders. Five male patients, four with unknown genotypes and treated with standard IFN alone, relapsed late (following SVR, 9%). Five patients, all treated with pegylated IFN and ribavirin, were reinfected (one prior to and four following SVR).
  
  
  CONCLUSIONS
  Prisoners are often successfully treated for CHC. However, this retrospective study indicates that there is a high (17%) prevalence of late recurrence of viremia that is likely a reflection of reinfection due to ongoing risk-taking behavior.
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: John P
authors.initials: JP
authors.lastname: Bate
authors.forename: Anton J
authors.initials: AJ
authors.lastname: Colman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Frost
authors.forename: David R
authors.initials: DR
authors.lastname: Shaw
authors.forename: Hugh A J
authors.initials: HA
authors.lastname: Harley
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D055030:Drug Users / Q000706:statistics & numerical data; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008297:Male; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D013021:South Australia / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral; D012254:Ribavirin; D007372:Interferons