People are still having a hard time getting insurance coverage for hepatitis C treatment. Although it appears that healthcare is abandoning people living with hepatitis C, few are more ignored than people who are in jails and prisons.
In the early phases of the HCV Guidelines, the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America, assigned a high treatment priority for the incarcerated. Now the guidelines simply recommend treatment for everyone with hepatitis C, except those with a short life expectancy.
The Reality of Incarcerated Persons with Hepatitis C
Hepatitis C prevalence in the U.S. is determined by data collected from the National Health and Nutrition Examination Survey (NHANES). Since this household survey only sampled non-institutionalized people, we don’t know how many incarcerated people have hepatitis C. The Centers for Disease Control and Prevention (CDC) estimate that of the 2.2 million people in U.S. jails and prisons, 30% have hepatitis C. Other estimates are between 17% and 60%. Compared to the prevalence of HCV in the general population (1.6%), hepatitis C rates in prisons and jails are high.
Arguments in Favor of Offering HCV Treatment to the Incarcerated
Since more than 90% of those in prison will be released, treating the incarcerated is good for all of us. The HCV Guidelines state, “Persons who have successfully achieved an SVR (virologic cure) no longer transmit the virus to others…successful treatment benefits public health.” With such a high density of HCV+ people, prisons seem like an excellent place to offer treatment.
Furthermore, with a 1% acute HCV infection rate in prisons, it is also good for others in prison. With high-risk behaviors such as injection drug use, tattooing, men having sex with men, violence, and sharing of personal care items, it is surprising that the acute HCV rate isn’t higher. However, it may be higher, since hepatitis C is not well tracked in prison.
Various state prison systems see the logic in treating hepatitis C in this at-risk population. Illinois and Iowa made national news when they approved Sovaldi to treat HCV patients. Other states are considering this, while some have clearly rejected the idea.
From a medical standpoint, it makes sense to treat HCV in prisons. Healthcare delivery is always the right thing to do. It is never OK to turn our backs on anyone who needs medical care.
Arguments Opposing HCV Treatment for the Incarcerated
Medically, there are no reasons to withhold HCV treatment in prisons. The new drugs are easier to tolerate, lifting the decades-old concern about the neuropsychiatric side effects that accompanied ribavirin and interferon.
One could argue that the cost of medications makes treatment prohibitive. The problem with this argument is that if we don’t treat hep C in everyone as early as possible, we may face a more serious and expensive problem. Cirrhosis, liver cancer, and transplantation cost far more than treating HCV in its early stages. This just pushes the problem down the line, leaving someone to have to pay for the patient’s medical care, whether that patient is incarcerated or released. Moreover, even if you are able to cure HCV in a cirrhotic patient, you still have a patient with a serious liver disease, so you haven’t gained anything.
There is also the argument that patients who are cured may become reinfected with HCV, and you have wasted money treating them. That is like saying that someone in a knife fight might get stabbed again, so we shouldn’t stitch the wound. It sounds crazy, but isn’t that what we are saying?
Caring for the sick is always the right thing to do. Withholding healthcare is inhumane and immoral. No one is excluded from the Hippocratic Oath. “With regard to healing the sick…I will take care that they suffer no hurt or damage.”
Centerforce – Hepatitis Education Tools
Centers for Disease Control and Prevention – Hepatitis C and Incarceration