Digestive Diseases and Sciences

, Volume 50, Issue 4, pp 714–718 | Cite as

Evaluation of the Federal Bureau of Prisons Protocol for Selection of Which Hepatitis C–Infected Inmates Are Considered for Treatment

  • Monica M. Pradhan
  • Ronald Horswell
  • Glenn Jones
  • Jennifer L. Ramsey
  • William Cassidy


The Federal Bureau of Prisons limits hepatitis C therapy to those inmates with certain biochemical abnormalities. To evaluate this protocol, an analysis was done on data collected on hepatitis C infected inmates in the Louisiana Department of Corrections. A quality assurance database of hepatitis C infected inmates evaluated in the Louisiana Department of Corrections was reviewed for liver biopsy and laboratory results. Patients were compared as to whether they would have been biopsied under the Federal Bureau of Prisons protocol and if there were histologic differences between those who would and those who would not have been biopsied. Of 490 inmates biopsied, 26% (129) had an alanine aminotransferase level between one and two times the upper limit of normal without other biochemical abnormalities. If treating stages 2–4, 48% of these would qualify for treatment (15% if treating stages 3–4). There was no statistical difference between this group and either the group with an alanine aminotransferase level between one and two times the upper limit of normal and with other laboratory abnormalities or the group with an alanine aminotransferase level greater than or equal to two times the upper limit of normal and without other abnormalities. In the Louisiana Department of Corrections, the Federal Bureau of Prisons protocol was neither sensitive nor specific enough at identifying those that should be considered for hepatitis C therapy.


hepatitis C liver fibrosis prisons inmates 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ruiz JD, Molitor F, Sun RK, et al.: Prevalence and correlates of hepatitis C virus infection among inmates entering the California correctional system. West J Med 170(3):156–160, 1999Google Scholar
  2. 2.
    Baillargeon J, Wu H, Kelley MJ, Grady J, Linthicum L, Dunn K: Hepatitis C seroprevalence among newly incarcerated inmates in the Texas correctional system. Public Health 117(1):43–48, 2003Google Scholar
  3. 3.
    Cassidy WM: Treating hepatitis C in prisons. In Management of Hepatitis C in Prisons, San Antonio, 2003, pp 7.84–7.92Google Scholar
  4. 4.
    Federal Bureau of Prisons: Clinical practice guidelines for the prevention and treatment of viral hepatitis. February 2003.; accessed May 2004
  5. 5.
    Bedossa P, Poynard T: An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 24(2):289–293, 1996CrossRefPubMedGoogle Scholar
  6. 6.
    Montalto G, Zignego AL, Ruggeri MI, et al.: Serum HCV-RNA and liver histologic findings in patients with long-term normal transaminases. Dig Dis Sci 42(8):1703–1707, 1997Google Scholar
  7. 7.
    Rossini A, Ravaggi A, Agostinelli E, et al.: Virological characterization and liver histology in HCV positive subjects with normal and elevated ALT levels. Liver 17(3):133–138, 1997Google Scholar
  8. 8.
    OHRP Guidance on the Involvement of Prisoners in Research: Office for Human Research Protections, 2003; accessed May 2004Google Scholar
  9. 9.
    Poynard T, McHutchison J, Manns M, Myers RP, Albrecht J: Biochemical surrogate markers of liver fibrosis and activity in a randomized trial of peginterferon alfa-2b and ribavirin. Hepatology 38(2):481–492, 2003Google Scholar
  10. 10.
    Range S: Michigan’s silent epidemic: Hepatitis C. Lansing State 2004.; accessed May 2004
  11. 11.
    Theodore D, Dougherty KA, Smith P, et al.: Increasing liver-related mortality in incarcerated populations. Hepatology 38(4):694A, 2003Google Scholar
  12. 12.
    National Institutes of Health Consensus Development Conference Statement: Management of hepatitis C: 2002–June 10–12, 2002. Hepatology 36(5, Suppl 1):S3–S20, 2002Google Scholar
  13. 13.
    Zeuzem S, Diago M, Gane E, et al.: International, multicenter, randomized, controlled study for the treatment of patients with chronic hepatitis C and persistently normal ALT levels with peginterferon alfa-2a (40kd) (Pegasys®) and ribavirin (Copegus®). Hepatology 38(Suppl 1):208A, 2003Google Scholar
  14. 14.
    Sterling RK, Stravitz RT, Luketic VA, et al.: A comparison of the spectrum of chronic hepatitis C virus between Caucasians and African Americans. Clin Gastroenterol Hepatol 2(6):469–473, 2004Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Monica M. Pradhan
    • 1
  • Ronald Horswell
    • 1
  • Glenn Jones
    • 1
  • Jennifer L. Ramsey
    • 1
  • William Cassidy
    • 1
    • 2
  1. 1.Department of MedicineLouisiana State University Health Sciences CenterBaton RougeUSA
  2. 2.Earl K. Long Medical CenterBaton RougeUSA

Personalised recommendations