Personality disorders do not affect treatment outcomes for chronic HCV infection in Spanish prisoners: the Perseo study.
BACKGROUND
The link between infection with hepatitis C virus (HCV) and personality disorders (PD) has not been investigated in detail. The aim of this study was to compare the effectiveness of HCV treatment in prisoners with and without PD.


METHODS
We performed a prospective multicentre study in inmates from 25 Spanish prisons who had been treated with pegylated interferon alfa-2a plus ribavirin in 2011. PD diagnosis was based on the Personality Diagnostic Questionnaire-4+. We calculated adjusted Odds Ratios (AOR) and 95 % confidence intervals (95 % CI) using logistic regression.


RESULTS
The sample included 236 patients (mean age: 40.3 years, 92.8 % male, 79.2 % intravenous drug users, and 26.3 % HIV-coinfected). The prevalence of PD was 72.5 %. 32.2 % of patients discontinued treatment; this percentage was higher in patients with HCV genotypes 1/4 (AOR = 3.55; CI:1.76-7.18) and those without PD (AOR = 2.51; 1.23-5.11). Treatment discontinuation was mainly for penitentiary reasons (40.3 %): release or transfer between prisons. The rate of sustained viral response (SVR) was 52.1 % by ITT and 76.9 % by observed treatment (OT). SVR was higher among patients with genotype 2 or 3, and those with low baseline HCV-RNA. We did not observe any differences between individuals with and without PD in term of SVR, HCV genotype or HIV infection.


CONCLUSIONS
Our results support the safety and clinical effectiveness of the treatment of chronic HCV infection in correctional facilities, both in prisoners with PD and those without. Our data support non-discrimination between patients with and without PD when offering treatment for HCV infection to prison inmates.


BACKGROUND
Trial registration number (TRN) NCT01900886 . Date of registration: July 8, 2013.
Barcelona Men's Penitentiary Health Services, Barcelona, Spain. amarco@aspb.cat.|CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain. amarco@aspb.cat.
Andrés
A
Marco
Albolote Penitentiary Health Services, Granada, Spain. quinoab@gmail.com.
José J
JJ
Antón
Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), CIBER Salud Mental (CIBERSAM), Barcelona, Spain. jtrujols@santpau.cat.
Joan
J
Trujols
Fontcalent Penitentiary Health Services, Alicante, Spain. pabloshz@coma.es.
Pablo
P
Saíz de la Hoya
Córdoba Penitentiary Health Services, Córdoba, Spain. vivaperejil1@gmail.com.
José
J
de Juan
Sevilla Penitentiary Health Services, Sevilla, Spain. ifaraco60@gmail.com.
Inmaculada
I
Faraco
CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain. jcayla@aspb.cat.|Epidemiology Service, Barcelona Public Health Agency, Plaza Lesseps 1, 08023, Barcelona, Spain. jcayla@aspb.cat.
Joan A
JA
Caylà
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010554:Personality Disorders / Q000150:complications / Q000523:psychology*; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011329:Prisoners / Q000523:psychology*; D011330:Prisons; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use*; D013030:Spain; D016896:Treatment Outcome; D055815:Young Adult
D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a