@article{10902/16082,
year = {2018},
url = {http://hdl.handle.net/10902/16082},
abstract = {OBJECTIVES:
Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Our aim was to create a permanent program of HCV elimination in a prison based on a "test and treat" strategy.

METHODS:
This open-label clinical trial was conducted in the Spanish prison "El Dueso" between May 2016 and July 2017. Viremic patients were treated with a ledipasvir-sofosbuvir regimen (8-12 weeks) according to the 2015 Spanish Guidelines. A teleconsultation program was established to follow-up patients from the hospital. Non-responders were submitted for a phylogenetic analysis and offered retreatment. An evaluation of new cases of HCV infection was performed every 6 months and upon release in all inmates.

RESULTS:
847 (99.5%) inmates accepted to participate. HCV antibodies were present in 110 (13.0%) and 86 (10.2%) had detectable viremia. Most of them were genotype 1 or 3 (82.6%) and had <F2 fibrosis (52.2%). Treatment was started in the 69 inmates whose stay in prison was longer than 30 days. Sustained virological response was achieved in 64 out of 66 patients (96.9%), three of whom were successfully rescued with a salvage regimen after treatment failure. Two patients were lost to follow-up and three are currently on treatment without viremia. As a result, by July 2017 none of the 409 imprisoned was viremic, and neither reinfections nor de novo infections were detected.

CONCLUSIONS:
A sustained "test-and-treat" strategy against HCV in prisons is feasible and beneficial. Spreading this strategy should entail a public health impact.},
organization = {Supported by Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad, cofinanced by European Development Regional Fund “A way to achieve Europe”,Operative program Intelligent Growth 2014–2020 and grant PIE15/00079. This study received funding assistance from Gilead Sciences, Spain (IN-ES-337-2089), C/Vía de los Poblados, 3, 28033 Madrid, Spain, http://www.gilead. com/about/worldwide-operations/europe/spain; phone number: +34 913789830), who played no part in study design, data analysis, or in the preparation of the manuscript. All study investigators declare to be independent from funders.},
publisher = {Springer Nature},
publisher = {Am J Gastroenterol. 2018 Nov;113(11):1639-1648},
title = {Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm},
author = {Cuadrado Lavín, Antonio and Llerena Santiago, Susana and Cobo, Carmen and Pallás, José Ramón and Mateo, Miguel and Cabezas González, Joaquín and Fortea Ormaechea, José Ignacio and Álvarez, Silvia and Pellón, Raúl and Crespo del Pozo, Juan and Echevarría Vierna, Santiago and Ayesa Arriola, Rosa and Setién Suero, María Esther and López Hoyos, Marcos and Crespo Facorro, Benedicto and Agüero Balbín, Jesús and Chueca, Natalia and Garcia, Federico and Calleja, Jose Luis and Crespo García, Javier},
}