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Serum marker magic? Targeting hepatitis C
By Jim Montalto, News Editor
Published: 10/08/2007

Abstract 8 The Infectious Diseases in Corrections Report delves once again into the stormy waters of how, why and when to treat inmates plagued with hepatitis C virus infection. In its September issue, IDCR Chief Editor, Dr. David A. Wohl, Associate Professor of Medicine Division of Infectious Diseases at University of North Carolina’s AIDS Clinical Research Unit, wastes no time explaining why HCV treatment is such an explosive, and continually relevant, issue for corrections.

“Saddled with an astoundingly high prevalence of HCV among inmates, prisons and jails have had to deal with the cruel double edge of HCV treatment; therapy can be curative but is expensive, difficult to tolerate and has disappointingly low rates of success. The limitations of HCV therapy have prompted many correctional systems to withhold or restrict this treatment. Meanwhile, as HCV therapy has become more commonplace in the free world and clinical studies make clear the benefits of treatment, there has been increasing pressure for HCV therapy to be made widely available to prisoners.”

Due to the unsteady support for treatment, IDCR brings to light a cutting edge strategy by the Texas Department of Criminal Justice that identifies patients most appropriate for HCV therapy while avoiding the expense of a liver biopsy.

The approximately 400,000 inmates with HCV make the potential cost of comprehensive screening, testing, treatment, and prevention programs exorbitant, and funding for HCV treatment within corrections is scarce as it is. As a result, Dr. David Paar, Director of Clinical Virology at the University of Texas Medical Branch - Correctional Managed Care, emphasizes the importance of investigating alternative therapies.

While, liver biopsy, using ALT levels to discern therapy, and treatment deferral are mentioned as viable ways to deal with HCV, Paar investigates why and how the TDCJ uses the hepatic fibrosis serum marker, known as the AST Platelet Ratio Index (APRI), in its HCV evaluation and treatment guidelines.

Paar outlines what serum markers can do - “Serum markers of hepatic fibrosis reflect the state of fibrosis and fibrogenesis within the liver. These markers can be divided into two groups: Indirect and direct markers. Indirect markers include common clinical tests such as platelet counts, serum transaminases, glutamyl transpeptidase (GGT), and total bilirubin - all of which measure hepatic function. In contrast, the direct serum markers more accurately reflect the complex process of fibrogenesis,” - and then details how TDCJ worked with the APRI.

As TDCJ’s work continues, Paar closes his article by emphasizing the importance of implementing treatment guidelines that promote cost effective ways of evaluating and treating HCV infections through non-invasive fibrosis assessments.

In the rest of its issue, IDCR also discusses a unique New York State program that promotes continuing HCV therapy after release, along with the legal challenges of HCV management in a correctional setting.

Click here to read the full September report.


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