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| Inmate Hepatitis C Treatment in Montana |
| By missoulian.com |
| Published: 09/23/2003 |
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Eleven Montana prison inmates will be the first in the state prison system to receive treatment for hepatitis C, a viral infection that has become one of nation's leading causes of severe liver disease. Prisoners have been demanding treatment for years - several have actually sued the state - but Department of Corrections medical director Liz Rantz said she suspects that some of those now qualified for treatment will turn it down once they realize all it entails. In addition to getting a liver biopsy - in which a doctor removes a small core of tissue from the liver by inserting a long needle into the abdomen - they will have to spend a year taking two antiviral drugs, interferon and ribavirin. The drug combination can be quite toxic. 'The side effects are so devastating,' Rantz said. 'You have a year, basically, of feeling like you have the flu.' And the results aren't guaranteed. For the most common strain of hepatitis C, the drugs will wipe out the virus in only about one-half of the people who take them, according to the U.S. Centers for Disease Control and Prevention. The drugs are about 80 percent effective in treating two other less common strains of the virus. Getting sick from the virus is also not guaranteed. Usually, Rantz said, the virus will simply linger, symptom-free, in the liver. About 15 percent of the people who are infected will develop an immune response that completely wipes out the virus, although they will continue to test positive for hepatitis C antibodies. And, over 20 years, 15 percent to 20 percent of infected people will eventually develop cirrhosis, and a much smaller number will develop a form of liver cancer. There is no way to predict who will fall into which category. And there is no vaccine, so it's best for the sake of public health that people who have the disease know it, and can avoid passing it on to others through contact with blood and blood products. Although the most common source of infection used to be tainted transfusions (all donated blood is now screened for the virus), shared needles used to inject illegal drugs is now the top transmission route. The spread of hepatitis C is particularly worrisome in prisons, where it is much more common than in the general population. Nationwide, the U.S. Centers for Disease Control and Prevention estimates that as many as 41 percent of prison inmates will test positive for hepatitis C, while only 1.8 percent of people on the outside are carriers. Of the approximately 2,000 inmates in the Montana prison system, about 15 percent test positive for hepatitis C, Rantz said. All Montana inmates are screened for hepatitis C when they enter the prison system, and Rantz has reviewed the medical files of every inmate who has tested positive to find the 11 prisoners who qualify for the new drug treatment program. Rantz developed the criteria for treatment in cooperation with the state Department of Public Health and Human Services, following recommendations from the National Institutes of Health, the CDC and other states. Prisoners who could be released within the next three to four years will not qualify, Rantz said, because continued treatment is not guaranteed after they leave the prison. Prisoners who don't show evidence of active liver disease will not qualify, either, Rantz said. And prisoners who are in the final stages of liver disease won't benefit from the drugs, she said. They will get medical care for their diseased livers, however, and that has always been the case. Everyone who tests positive, regardless of whether they get the antiviral drugs, will get counseling about the disease and its progression, how to take care of their health and how to avoid spreading it. People who test positive for hepatitis C also get vaccinated against hepatitis A and B. The cost of treating hepatitis C - about $15,000 per inmate - was also not the driving factor, although it did play some part. And for long-term inmates, it turns out to be less expensive to treat their hepatitis C before they develop end-stage liver disease. Joe Williams, a spokesman for the state Department of Corrections, said the cost can be a tough sell, but the public health benefits are worth the expense of the new program. Other states are working through the same issue. In January, Rantz and Department of Corrections Director Bill Slaughter attended a national conference on hepatitis C in prisons. Also in January, the CDC issued a set of recommendations for prison systems trying to decide which inmates to treat. |
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