Objective: Imprisonment entails a golden opportunity for chronic hepatitis C treatment, as treatment adherence can easily be achieved in this setting. The objective of this study was to determine the proportion and causes of discontinuation of chronic hepatitis C therapy among the Spanish penitentiary population.
Methods: This is an observational, prospective multicenter study performed in 26 Spanish penitentiaries between October 2007 and December 2009. Patients with chronic hepatitis C who were undergoing treatment with pegylated interferon plus ribavirin in accordance with clinical practice were included. The primary variable in the study was the proportion of discontinuation of treatment for chronic hepatitis C.
Results: A total of 431 patients were included in this analysis (92.3% male; mean age, 37.9±6.3 years; 66.4% with high viral load; genotype 1, 51.0%; genotype 3, 35.7%; genotype 4, 11.8%; genotype 2, 1.4%; coinfected with HIV, 24.4%). The proportion of treatment discontinuation for chronic hepatitis C was 22.5% (n=97; 95% confidence interval: 18.65-26.75). Therapy discontinuation was more frequent during the first trimester of treatment (n=45; 46.4%), and release from prison was the most frequent cause for treatment discontinuation (n=35; 36.1% of discontinuations). Among 407 patients included in the efficacy analysis, sustained viral response was achieved in 52.1% (95% confidence interval: 47.12-57.02).
Conclusion: Treatment discontinuation for chronic hepatitis C in the penitentiary setting is low. However, further efforts should be made to improve the coordination between penitentiary institutions and external centers to ensure treatment after the inmates are released or transferred to other prisons.