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| Success in the Hep. C treatment haze |
| By Jim Montalto, News Editor |
| Published: 02/26/2007 |
This month's Infectious Diseases in Corrections Report addresses both the plight of hepatitis C virus (HCV) infection and the debate being undertaken among those in corrections about HCV therapy during incarceration. According to the report, even though the prevalence of HCV in prisons and jails exceeds 30 percent, with some prisons reporting a 50 percent rate of infection, screening for HCV in many correctional facilities is not regular protocol.The HCV management and care standards that have been established call for an increase in treatment among inmates, but the solution to this challenge involves far more than a simple test and a pill, which isn't unusual when it comes to corrections. HCV therapies are expensive, which threaten to deplete or strain facility health care budgets. In addition, there are concerns among health care practitioners of the inmates' tolerability to the therapies. Different facilities also have adopted different and individualized approaches to financing HCV therapy, which has made it difficult to follow any one standard. But, “the medical management of this infection in our correctional system should be much less variable,” IDCR editor David Wohl writes. “As detailed in IDCR (October, 2005, July 2005), guidelines for the diagnosis and treatment of HCV have been established and include recommendations made by the National Institutes of Health (NIH) and the American Association for the Study of Liver Disease (AASLD) among others.” To encourage more thought and effort into addressing HCV and pertinent, relevant therapies, Drs. Kay Bauman and Steven DeWitt, from the Hawaii Department of Public Safety, discuss their approach to both successfully managing complications and completing treatments associated with HCV treatment. Wohl says their success should be a reassuring factor for correctional clinicians considering implementing HCV treatment programs. In their article, Managing the Side Effects of Hepatitis C Treatment in a Correctional Environment, Bauman and DeWitt lay out in their statistics and methodologies behind their strategies. Their general approach and philosophy to treatment, for example, is to “aim to assign a nurse at each facility to take responsibility for HCV management and also get the active participation of the nurse administrator. The overall management of HCV from diagnosis, evaluation and consideration of liver biopsy, explanation of the rationale for decisions not to treat (e.g., liver biopsy with fibrosis 0-1), to supportive care during treatment, all require the involvement of a consistent team of nurses and other providers. Most clinical visits (frequently timed with lab draws) are with the nurse on the treatment team. He or she assesses whether or not additional physician visits are also needed. ”Patient expectations play a major role in the subjective patient response to side effects. During counseling, we stress the potential benefits of the current treatment and use the term "chemotherapy" to describe the treatment course itself. Some believe this is too strong a term, but our experience supports using this term, as it better predicts for the patient the severity of the side effects. We believe forewarned is fore-armed. We explain the 60/40 "odds" of achieving a sustained viral response (SVR; non-detectable virus at 6 months post treatment) or "cure" for HIV-uninfected patients with genotype 1 HCV, but also the potential reduction in liver inflammation and the resultant delay in the complications from chronic HCV even in the absence of SVR.3 This we describe to the patient as "turning the clock back" on this disease. “ Then they discuss the common side effects practitioner can expect including, but not limited to, nausea, weight loss, depression, skin irritation and chills. Bauman and DeWitt also detail other more complex side effects they witnessed like hematologic complications, bacterial infections and decompensation of liver disease. A series of case discussions by Albany Medical College's Dr. Douglas Fish complements the Bauman, DeWitt report. To read the entire IDCR report, go to idcronline.org |
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