Prisoner Health Update: Hepatitis C
by Eike Blohm, MD
Hepatitis C (HepC) is inflammation of the liver due to the Hepatitis C Virus (HCV). The virus infects about 1 to 2% of the U.S. population, but it is likely the most prevalent infection in American prisons. As there are no national standardized testing protocols or reporting requirements for HCV in U.S. prisons, prevalence estimates vary widely; our best estimate of the prevalence of HCV infection among incarcerated Americans is somewhere between 15 and 40%. Of those, over 1,100 die each year of HepC complications, even though a cure has been available for a decade.
HCV is transmitted by blood. Unlike HIV, which requires the transfer of a small drop of blood between individuals to cause infection, HCV can be transmitted with a microscopic amount of blood too small to see with the naked eye. It is therefore common among IV drug users who share needles. But it can also be spread through unprotected sex, including oral sex and anal intercourse, as well as by dirty piercing or tattooing equipment.
The Function of The Liver
The main task of the liver is to detoxify the blood, but that isn’t its only job. It breaks down the hemoglobin of old blood cells which in turn creates the pigments that color urine yellow and stools brown. The liver also makes bile to help digestion, and it synthesizes clotting factors that allow us to stop bleeding after an injury. In addition, the liver makes albumin, a protein that acts a bit like a sponge to prevent water from leaking out of the bloodstream. Because of its many unique and specialized functions, no drug or machine exists that allows a person to live after complete liver failure — so it is fatal.
Symptoms of Hepatitis C
A person newly infected with HCV will develop ACUTE hepatitis. This comes with fever, pain over the liver — underneath the right lower ribs — and loss of the normal functions described above. The pigment from hemoglobin breakdown is no longer added to the stools, which can make bowel movements appear gray. Its precursor (bilirubin) accumulates in the body and turns the whites of the eye yellow and makes urine dark, like iced tea.
As the immune system learns to combat the virus, symptoms will disappear in 1–2 weeks. In about one-third of cases, the immune system wins and completely kills the virus. But in the majority of those infected with HCV, the virus smolders, silently damaging the liver over a period of years — what is known as CHRONIC HepC.
Chronic HepC slowly scars the liver — cirrhosis — and the symptoms described above return without the fever. HCV is also one of the few viruses that can cause cancer; people with chronic HepC are at high risk of hepatocellular carcinoma (liver cancer).
Diagnosis
HCV is diagnosed with a simple blood or saliva test that looks for antibodies against HCV or HCV RNA.
Treatment
A decade ago, a new group of drugs (e.g., Harvoni) came to the market that can cure HCV in 95% of people. Treatment consists of a daily pill for 12 weeks. These drugs are expensive, costing between $15,000 to $24,000 for one complete treatment cycle. Of note, the treatment does NOT reverse any damage the liver has already taken. It also does NOT protect a person from re-infection with HCV later on.
Hurdles
The standard of care is to treat a person who is HCV-positive, despite the expense. This prevents spread of the virus to other persons, protects the liver from cirrhosis, and forestalls liver cancer. But many prisons attempt to skirt their responsibility to provide adequate medical care because of the high price tag associated with HCV drugs.
But treating every prisoner with Hepatitis C would cost about 70% of the entire medical budget for all U.S. prisons. So, since damage from HepC takes many years, why not kick the can down the road until the person is released from custody? It is unethical and potentially deliberately indifferent to withhold treatment from a prisoner known to be HCV-positive, but there is an easy fix for that: Prisons just stop testing for HCV, thereby preserving their institutional ignorance.
Prisoners therefore must be their own advocates and actively seek out testing and treatment if they believe they are at risk of HepC. PLN seeks to empower prisoners by providing information regarding available diagnostic and treatment options for Hepatitis C.
Disclaimer: This column aims to educate prisoners about a common health condition, but it does not constitute medical advice and is no substitute for evaluation by a trained medical professional.
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