Infection

, Volume 45, Issue 2, pp 131–138 | Cite as

Management of HCV infection in the penitentiary setting in the direct-acting antivirals era: practical recommendations from an expert panel

  • Roberto Ranieri
  • Giulio Starnini
  • Sergio Carbonara
  • Emanuele Pontali
  • Guido Leo
  • Antonio Romano
  • Sandro Panese
  • Roberto Monarca
  • Tullio Prestileo
  • Giorgio Barbarini
  • Sergio Babudieri
  • on behalf of the SIMSPe Group
Review

Abstract

Background

The prevalence of HCV infection is higher among prisoners than in the general population. The introduction of HCV direct-acting antivirals (DAA) holds the potential to improve clinical outcomes also in inmates. However, treatment of hepatitis C in inmates has to face several clinical and logistical issues which are peculiar of prison environment. Recommendations on the management of HCV infection specific for the penitentiary setting in the DAA era remain scant. The Italian Society for Penitentiary Medicine and Healthcare has, therefore, issued these recommendations, to provide clinicians with a guide for the comprehensive management of HCV infection in the restriction setting, taking into account its peculiar characteristics.

Results

Dedicated diagnostic and treatment procedures should be established in each prison. In particular, the use of DAAs appears crucial to provide patients with an effective therapeutic option, able to overcome the limitations of IFN-based regimens with a short period of treatment. DAA treatment should be initiated as soon as possible in all eligible subjects with the aim to cure the patient, as well as to limit the transmission of HCV infection both inside the penitentiary system and to the free community, once the inmates ends his/her release. Importantly, efforts should be made to open a discussion with regulatory bodies, to define specific regulations aimed to guarantee wide access to effective therapies of all eligible patients, to optimize the management of and the adherence to the HCV treatment, and to ensure the therapeutic continuity after discharge from prison.

Keywords

DAA HCV Infection Penitentiary medicine Management 

Notes

Acknowledgements

Editorial assistance for the preparation of this manuscript was provided by Luca Giacomelli, PhD; this assistance was supported by an unrestricted grant by Abbvie.

Compliance with ethical standards

Conflict of interest

None relevant.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Roberto Ranieri
    • 1
    • 2
  • Giulio Starnini
    • 2
    • 3
  • Sergio Carbonara
    • 2
    • 4
  • Emanuele Pontali
    • 2
    • 5
  • Guido Leo
    • 2
    • 6
  • Antonio Romano
    • 7
  • Sandro Panese
    • 8
  • Roberto Monarca
    • 2
    • 9
  • Tullio Prestileo
    • 10
  • Giorgio Barbarini
    • 11
    • 12
  • Sergio Babudieri
    • 2
    • 13
  • on behalf of the SIMSPe Group
  1. 1.Azienda Ospedaliera Santi Paolo e Carlo Penitentiary Infectious Diseases UnitUniversity of MilanMilanItaly
  2. 2.SIMSPe-Italian Society for Penitentiary Medicine and HealthcareSassariItaly
  3. 3.U.O.C. Medicina protetta-Malattie infettiveViterboItaly
  4. 4.Clinic of Infectious DiseasesUniversity of BariBariItaly
  5. 5.Infectious Disease UnitOspedale GallieraGenoaItaly
  6. 6.Infectious Disease UnitOspedale Amedeo di SavoiaTurinItaly
  7. 7.Cisanello HospitalPisaItaly
  8. 8.Ospedale dell’Angelo Malattie infettive e TropicaliVeniceItaly
  9. 9.Ospedale BelcolleViterboItaly
  10. 10.ARNAS, Ospedale Civico-Benfratelli PalermoPalermoItaly
  11. 11.Malattie Infettive e Tropicali IRCCS San MatteoUniversità di PaviaPaviaItaly
  12. 12.Case Circondariali di PaviaVoghera e VigevanoItaly
  13. 13.Infectious Disease UnitUniversity of SassariSassariItaly

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