title: Management of HCV infection in the penitentiary setting in the direct-acting antivirals era: practical recommendations from an expert panel.
abstract: BACKGROUND
  The prevalence of HCV infection is higher among prisoners than in the general population. The introduction of HCV direct-acting antivirals (DAA) holds the potential to improve clinical outcomes also in inmates. However, treatment of hepatitis C in inmates has to face several clinical and logistical issues which are peculiar of prison environment. Recommendations on the management of HCV infection specific for the penitentiary setting in the DAA era remain scant. The Italian Society for Penitentiary Medicine and Healthcare has, therefore, issued these recommendations, to provide clinicians with a guide for the comprehensive management of HCV infection in the restriction setting, taking into account its peculiar characteristics.
  
  
  RESULTS
  Dedicated diagnostic and treatment procedures should be established in each prison. In particular, the use of DAAs appears crucial to provide patients with an effective therapeutic option, able to overcome the limitations of IFN-based regimens with a short period of treatment. DAA treatment should be initiated as soon as possible in all eligible subjects with the aim to cure the patient, as well as to limit the transmission of HCV infection both inside the penitentiary system and to the free community, once the inmates ends his/her release. Importantly, efforts should be made to open a discussion with regulatory bodies, to define specific regulations aimed to guarantee wide access to effective therapies of all eligible patients, to optimize the management of and the adherence to the HCV treatment, and to ensure the therapeutic continuity after discharge from prison.
authors.affiliation: Azienda Ospedaliera Santi Paolo e Carlo Penitentiary Infectious Diseases Unit, University of Milan, Milan, Italy.|SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ranieri
authors.affiliation: SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy.|U.O.C. Medicina protetta-Malattie infettive, Viterbo, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Starnini
authors.affiliation: SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy.|Clinic of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Carbonara
authors.affiliation: SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy.|Infectious Disease Unit, Ospedale Galliera, Genoa, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pontali
authors.affiliation: SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy.|Infectious Disease Unit, Ospedale Amedeo di Savoia, Turin, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Leo
authors.affiliation: Cisanello Hospital, Pisa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Romano
authors.affiliation: Ospedale dell'Angelo Malattie infettive e Tropicali, Venice, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Panese
authors.affiliation: SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy.|Ospedale Belcolle, Viterbo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Monarca
authors.affiliation: ARNAS, Ospedale Civico-Benfratelli Palermo, Palermo, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Prestileo
authors.affiliation: Malattie Infettive e Tropicali IRCCS San Matteo, Università di Pavia, Pavia, Italy.|Case Circondariali di Pavia, Voghera e Vigevano, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Barbarini
authors.affiliation: SIMSPe-Italian Society for Penitentiary Medicine and Healthcare, v.le San Pietro35/b, 07100, Sassari, Italy. babuder@uniss.it.|Infectious Disease Unit, University of Sassari, Sassari, Italy. babuder@uniss.it.
authors.forename: Sergio
authors.initials: S
authors.lastname: Babudieri
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D017410:Practice Guidelines as Topic; D011330:Prisons
chemical_list: D000998:Antiviral Agents
keywords: DAA; HCV; Infection; Management; Penitentiary medicine