Chronic Viral Hepatitis in the Italian Prison Setting: Prevalence, Outcomes, Literature Needs and Perspectives

Fiore, Vito; Vito, Andrea De; Pontali, Emanuele; Lucania, Luciano; Madeddu, Giordano; Babudieri, Sergio

doi:10.3390/healthcare9091186

Cited by 6 publications

(10 citation statements)

References 23 publications

(43 reference statements)

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“…In agreement with what is known from the literature, in our study, HCV-genotype 1b was the most frequent in the general population, while HCV-genotype 3 was the most frequent in people from centers for addictions and in prison, for whom intravenous drug use is a leading risk factor for infection [38][39][40][41][42]. HCV-genotype 3 is responsible for the largest number of infections in Asian countries, such as India and Pakistan, and is estimated to have rapidly spread to Western countries through the practice of intravenous drug use [13,40,43,44].…”

Section: Discussionsupporting

confidence: 91%

Country-Wide HCV Elimination Strategies Need to Reach Older Patients in the General Population: The Italian Experience

Torre,

Coppola,

Masarone

et al. 2023

Viruses

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HCV infection is still a major burden worldwide, and most countries are not on track to meet the WHO 2030 elimination goal. The current challenge is to identify individuals to be treated. In this study, we will describe the trend of new DAA prescriptions and the changes over time in terms of the characteristics of patients starting antiviral therapy in our unit. Data of 1646 hepatitis C patients who started therapy during the period of 2015–2022 regarding annual number of prescriptions, age, gender, nationality, HCV genotype, provenance, and liver disease severity were analyzed. We observed a peak in the number of new prescriptions in 2018 and a downward trend starting in 2019. Patients from the general population, centers for addictions, and prison differed significantly. The mean age in the general population remained above 60 years, the percentage of patients from centers for addictions and prison increased and, after 2016, there was no significant change in the percentage of patients with F3–F4 fibrosis. As HCV screening and linkage-to-care pathways seem to be already well implemented and successful in centers for addictions and in prisons, efforts need to be focused on those of older age in the general population. To carry this out, the more structured involvement of different health professionals must be figured out.

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Section: Discussionsupporting

confidence: 91%

Country-Wide HCV Elimination Strategies Need to Reach Older Patients in the General Population: The Italian Experience

Torre,

Coppola,

Masarone

et al. 2023

Viruses

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“…In Italian penitentiary institutes, < 5% of incarcerated people are female. The limited women inclusion is one of the biggest limitations in the most part of the studies on prison settings [3,[8][9][10]. As consequence, the Specialist activity to reach them out should be pro-active.…”

Section: Discussionmentioning

confidence: 99%

“…Although the current national literature highlights how current micro-eradication strategies and new drugs could lead to similar results both in penitentiary settings and outside community, all available literature is concordant in defining incarcerated women as the harder-to-reach population [3,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

HCV spread among female incarcerated population and treatment pathways to viral elimination in Italian prison settings: clinical perspectives and medico legal aspects

et al. 2022

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Background Hepatitis C virus (HCV) infection is more frequent among incarcerated people than in general population. In the DAAs era, the short schedules and the low risk of adverse reactions, increased the number of HCV treatments. However, the most part of literature reports lack of incarcerated women inclusion in studies on field. Our aim is to assess the screening execution, HCV prevalence, and DAAs treatment among incarcerated women. A focused insight on quick vs standard diagnosis and staging approach will be also provided. Methods Incarcerated women from 4 Italian regions’ penitentiary institutes were included. HCV screening was executed with HCV saliva test (QuickOral Test®) or phlebotomy. Stage of liver fibrosis was evaluated with FIB-4 value or fibroscan®, based on physicians’ decision. Treatment prescription followed national protocols. Results We included 156 women, 89 (57%) were Italian, mean age was 41 ± 10 years, and 28 (17.9%) were people who inject drugs (PWIDs). Overall, the HCV seroprevalence was 20.5%. Being PWID and on opioid substitution therapy (OST) were significantly associated with serological status (p-value < 0.001). Of them, the 75.5% of patients had active infection, the most frequent genotype was 3a (50%). Among them, 4 (16.6%) and 6 (25%) had psychosis or alcohol abuse history. The 62.5%, 25% and 12.5% had low, intermediate, and advanced fibrosis, respectively. Out of the 24 HCV-RNA positive patients, the 75% underwent to DAAs treatment. The sustained virological response (SVR12) was achieved in 88.8% of cases. When evaluating the influence of quick diagnosis and staging methods vs standard phlebotomy and fibroscan® on SVR12, FIB-4 use showed higher performance for retainment in treatment during prison staying (p = 0.015), while the use of quick saliva test had no influence on the outcome (p = 0.22). Conclusion HCV seroprevalence and active infections are very high among incarcerated women. More tailored interventions should be focused on HCV diagnosis and treatment in female prison population. The use of quick staging methods (FIB-4) is useful to increase SVR12 achievement without delays caused by the fibroscan® awaiting.

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“…The most recent literature showed concordance with these data: incarcerated people with CHC are young (~40 years old) and with low liver fibrosis in the majority of cases (up to 96%) [16,18,21]. As a consequence, this is clearly a population which would benefit from strategies with quick testing and staging (with scores and not fibroscan ® ), followed by treatments with short schedules [22].…”

Section: Clinical Features and Outcomesmentioning

confidence: 72%

Facing HCV as a Major Public Healthcare Threat in Italy: Epidemiology and Micro-Elimination Pathways among Underserved Populations

et al. 2023

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Underserved populations have a wide heterogeneity on healthcare provision and use. They also represent the key populations according to WHO 2030 goals for HCV micro-elimination. Our review evaluated the available literature on HCV diagnosis, staging, and treatment among underserved populations, such as incarcerated people, patients with psychiatric disorders, and migrants. A narrative review of literature was performed using key electronic databases (Scopus, Pubmed—MEDLINE) and search engines (Google Scholar). Peer-reviewed publications, grey literature on HCV, and recent models proposed for micro-elimination in underserved populations were included. An insight into the COVID-19 pandemic and its influence on HCV micro-elimination pathways will be also provided. Regarding prison settings, a progressive reduction in HCV epidemiology among incarcerated people in the last years was found (one-third of the level it had been before). People suffering from psychiatric disorders have a high anti-HCV prevalence, but there is a lack of data on active infections. A bidirectional relationship between HCV and psychiatric disorders was found. Migrants showed a very inconsistent assessment of HCV. Furthermore, available studies recorded data from populations with high heterogeneity of anti-HCV prevalence, Therefore, the reported results need caution in their evaluation.

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Chronic Viral Hepatitis in the Italian Prison Setting: Prevalence, Outcomes, Literature Needs and Perspectives

Cited by 6 publications

References 23 publications

Country-Wide HCV Elimination Strategies Need to Reach Older Patients in the General Population: The Italian Experience

Country-Wide HCV Elimination Strategies Need to Reach Older Patients in the General Population: The Italian Experience

HCV spread among female incarcerated population and treatment pathways to viral elimination in Italian prison settings: clinical perspectives and medico legal aspects

Facing HCV as a Major Public Healthcare Threat in Italy: Epidemiology and Micro-Elimination Pathways among Underserved Populations

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