Researchers Propose Treating Prison Population to Fight US Hepatitis C Epidemic

Inmates have high prevalence of hepatitis C virus infection and are readily reachable for testing and treatment, says UC Riverside’s Scott Allen

Photo shows Scott Allen.

Scott Allen, MD, is a clinical professor of internal medicine at UC Riverside’s School of Medicine, where he is also the associate dean for academic affairs. Photo credit: I. Pittalwala, UC Riverside.

RIVERSIDE, Calif. — Nearly 4 million Americans may be infected with the hepatitis C virus, with many people unaware of their status.  The virus can take decades to make those infected ill with cirrhosis, cancer or liver failure.

Three researchers now argue in the May 15 issue of the New England Journal of Medicine (NEJM) that America’s oversized prison population provides a critical opportunity to tackle the U.S. hepatitis C epidemic. Inmates, they say, have a high prevalence of hepatitis C virus infection (one is six prisoners is infected) and are readily reachable for testing and treatment.

Most hepatitis C virus infection in the U.S. is due to past use of injection drugs.  More than 10 million Americans cycle in and out of prisons and jails each year, including nearly one of every three Americans infected with the hepatitis C virus.  Because more than 95 percent of prisoners are eventually released, most hepatitis C virus-related illness will occur in the community, the researchers write in their “perspective” article.

Scott A. Allen, MD, at the University of California, Riverside’s School of Medicine is one of the authors of the NEJM article.

Watch him summarize the key points of the article in this short video:

In the video, Allen, a professor of medicine, explains why we all ought to pay attention to the hepatitis C virus; what we can expect if nothing is done to address the epidemic; why the criminal justice system is the best place to cure the greatest number of people infected with the virus; how the treatment of prisoners would benefit society in the long run; and why the high cost of treating prisoners (currently, a single treatment course costs approximately $84,000 per person) is justified.

“Even with the high cost, the drugs appear to be cost-effective,” he says. “Private insurers in the community appear to be covering it. That establishes a clear community standard, and prisons will be held to that standard by the courts. The public policy question isn’t whether or not we pay for hepatitis C care but how we pay for it.”

It is estimated that more than a million Americans could die because of the hepatitis C virus by 2060; those who are spared will require critical and costly treatments, including liver transplants.

Allen coauthored the NEJM article with Josiah D. Rich, a professor of medicine and epidemiology at Brown University, RI; and Brie A. Williams, an associate professor of medicine at UC San Francisco.

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