Hepatitis C is a slow-progressing potentially-fatal viral disease that ultimately destroys the liver. Unlike HIV, the hepatitis C virus (HCV) is resilient, capable of surviving for weeks outside the human body. It is spread by blood-to-blood contact and is very common among users of intravenous drugs. The immune systems of about one in eight people infected with HCV will beat the infection. The other seven may require medication to defeat the virus.

Because many prisoners are former IV drug users, a large number of prisoners are infected with HCV. Prison officials estimate that as many as 50,000 of the approximately 150,000 Texas prisoners have HCV infections. However, only 20,000 Texas state prisoners are known to be infected with HCV. This is because only prisoners who have are infected with HIV or admit to past IV drug use are tested for HCV upon admission into the Texas Department of Criminal Justice (TDCJ). Even so, treating HCV in prisoners is very expensive.

The University of Texas Medical Branch Correctional Managed Care program (CMC) provides health care for about two thirds of TDCJ prisoners. Dr. Stephanie Zepeda, who supervises treatment of prisoners at CMC, said that she treats about 400 prisoners for HCV each month at a cost of around $2.8 million per year.

HCV Treatment lasts from 3 months to one year and not all prisoners with identified HCV infections are receiving treatment because the treatment protocol requires evidence that the HCV is seriously damaging the liver.

Current HCV treatment in TDCJ consists of two drugs and has a cure rate of around 40%. New medical guidelines call for the addition of a third drug, which can be one of two different available drugs. Use of the third drug raises the cure rate to 70%, but also increases the annual cost of treatment to $8 million or over $13 million depending on which third drug is used according to Zepeda. These new treatments are expected to significantly strain the TDCJ budget in the near future.

"It's great from a humanistic standpoint," said Zepeda. "But it's, practically, a challenge for the correctional system."

The new drugs bring other problems as well. They must be taken with food precisely every eight hours to avoid the development of drug-resistant HCV.

"It just takes a tremendous amount of coordination to do it right and to do it well," said Zepeda.

Additional considerations include the expected availability of new, possibly more effective HCV drugs with simpler protocols as early 2014 and a new Center for Disease Control recommendation to test everyone born between 1945 and 1965 for HCV. That age group accounts for almost 75% of all HCV cases. Over 25% of TDCJ prisoners belong to that age group and, according to Zepeda, more testing will result in the discovery of more cases of HCV infection and the need for more treatment at greater cost.

At the same time, failing to treat HCV is not an option. It is much more expensive to treat prisoners who are dying of liver disease. Prisoners with HCV infections who are released can spread the disease

"Ultimately, it's going to be much like HIV," said Dr. Owen Murray, vice president of CMC. "You're just going to have to acknowledge you have this disease in prison and that it costs a lot to treat."

Sources: New York Times, Texas Tribune

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