Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 28, 2015; 7(21): 2323-2330
Published online Sep 28, 2015. doi: 10.4254/wjh.v7.i21.2323
Hepatitis C virus infection and prisoners: Epidemiology, outcome and treatment
Rosa Zampino, Nicola Coppola, Caterina Sagnelli, Giovanni Di Caprio, Evangelista Sagnelli
Rosa Zampino, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Internal Medicine, Second University Naples, 80135 Naples, Italy
Nicola Coppola, Giovanni Di Caprio, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University Naples, 80135 Naples, Italy
Caterina Sagnelli, Department of Clinical and Experimental Medicine and Surgery “F. Magrassi e A. Lanzara”, Second University Naples, 80135 Naples, Italy
Evangelista Sagnelli, Department of Mental Health and Public Medicine, Second University Naples, 80135 Naples, Italy
Author contributions: Zampino R had conceived and drafted the article, and approved the final version; Sagnelli C and Di Caprio G reviewed the literature, contributed to drafting the article and approved the final version; Coppola N and Sagnelli E critically reviewed the manuscript and approved the final version of this article.
Conflict-of-interest statement: The authors declare no conflict of interest in connection with this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Rosa Zampino, MD, PhD, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Internal Medicine, Second University Naples, Via Pansini 5, Edificio 3, 80135 Naples, Italy.
Telephone: +39-81-5666708 Fax: +39-81-5666707
Received: April 23, 2015
Peer-review started: April 24, 2015
First decision: July 25, 2015
Revised: August 5, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: September 28, 2015

The studies on hepatitis C virus (HCV) infection in prison populations are few and mostly cross-sectional. We analyzed prevalently the articles appearing on PubMed in the last ten years. HCV infection is frequent in prisoners, prevalences ranging from 3.1% to 38% according to the HCV endemicity in the geographical location of the prison and in the countries of origin of the foreign prisoners and to the prevalence of intravenous drug use, which is the most important risk factor for HCV infection, followed by an older age of prisoners and previous prison terms. HCV replication in anti-HCV-positive cases varies from 45% to 90% in different studies, and the most common HCV genotypes are generally 1 and 3. The response to antiviral treatment is similar in prisoners to that of the general population. Unfortunately, treatment is administered less frequently to prisoners because of the difficulties in management and follow-up. The new directly acting antivirals offer a good therapy option for inmates because of their good efficacy, short duration of treatment and low incidence of side effects. The efforts of the prison authorities and medical staff should be focused on reducing the spread of HCV infection in prisons by extending the possibility of follow-up and treatment to more prisoners with chronic hepatitis C.

Keywords: Prisoners, Management, Treatment, Care, Chronic hepatitis C

Core tip: Hepatitis C virus (HCV) infection in prisoners is a social health problem: It is more frequent than in the general population, but access to proper management and treatment is more difficult. In this setting HCV infection can be easily transmitted due to overcrowded conditions, sharing supplies and particularly by drug use. In the past, HCV treatment was rarely administered to prisoners, often because they did not stay in the same structure long enough. Also, the risk of HCV re-infection is high in inmates. New policies should be applied to guarantee prisoners the same care as the general population, particularly in view of the new, shorter and more effective anti-HCV treatments.