Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm
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AuthorCuadrado Lavín, Antonio; Llerena Santiago, Susana; Cobo, Carmen; Pallás, José Ramón; Mateo, Miguel; Cabezas González, Joaquín; Fortea Ormaechea, José Ignacio; Álvarez, Silvia; Pellón, Raúl; Crespo del Pozo, Juan; Echevarría Vierna, Santiago; Ayesa Arriola, Rosa; Setién Suero, María Esther; López Hoyos, Marcos; Crespo Facorro, Benedicto; Agüero Balbín, Jesús; Chueca, Natalia; Garcia, Federico; Calleja, Jose Luis; [et al.]
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.
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.
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.
A sustained "test-and-treat" strategy against HCV in prisons is feasible and beneficial. Spreading this strategy should entail a public health impact.
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