[Drug-addicted prisoners: seroprevalence of human immunodeficiency virus and hepatitis B and C virus soon after the marketing of buprenorphine]

Research Note — Review of Corrections-Based Therapy for Opiate-Dependent Patients: Implications for Buprenorphine Treatment among Correctional Populations

Inmates with a history of opiate dependence represent a substantial proportion of the correctional population in the United States. Opiate use has negative consequences for both the inmate and society, including increased recidivism rates, increased infectious disease prevalence, avoidable emergency room use, decreased access to primary care services, and overdose. While there have been great successes in community-based treatment of opiate dependence, these successes have not yet been achieved in correctional settings. This paper reviews the pharmacological treatment options for opiate-dependent inmates, along with potential application for community-to-correctional approaches. The recent approval by the Food and Drug Administration (FDA) of physician-prescribed buprenorphine and the new opportunities it presents to corrections-based treatment are also explored in depth. Successful implementation of such strategies is likely to result in desirable health and social outcomes for both the inmate and the community at large.

Prevalence of human immunodeficiency virus and hepatitis C virus among French prison inmates in 2010: a challenge for public health policy

We evaluated prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among prison inmates in France in 2010, in a cross-sectional single-day study based on a two-stage design. Sampling favoured larger establishments and included all types of prisons. Establishments were stratified by geographical region. Estimates were adjusted by post-stratification of the total population of inmates in France. From 60,975 inmates in all 188 prisons on the sampling day, 2,154 were selected from 27 prisons, and 1,876 questionnaires completed. HIV prevalence was estimated at 2.0% (95% confidence interval (CI): 0.9–4.2), 2.6% (95% CI: 0.7–8.8) in women and 2.0% (95% CI: 0.9–4.3) in men; 75% of inmates were receiving treatment for HIV. HCV prevalence was estimated at 4.8% (95% CI: 3.5–6.5) and was higher for women (11.8%; 95% CI: 8.5–16.1) than men (4.5%; 95% CI: 3.3–6.3). Almost half of HCV-infected inmates had chronic hepatitis C and 44% were receiving or had received treatment. HIV and HCV prevalence was six times higher than in the general population, and 2.5% of inmates had viraemic hepatitis C. The moment of incarceration provides an ideal opportunity for testing and treating, limiting spread of HCV and improving patients' prognosis.

Access to treatment of hepatitis C in prison inmates

We conducted a prospective study to investigate access to treatment in hepatitis C in 268 prisoners. Hepatitis C positivity had been known for 182 prisoners previously and 19 reported previous attempts to treat (10%). In comparison, during our study, 86/268 prisoners (32%) started therapy (P < 0.0001). They represented 41% of 211 prisoners with a positive viral load. In the genotype 2 or 3 group, 46 prisoners (50%) started therapy versus 40 prisoners (33%) with other genotypes (P = 0.01). This difference was due to prisoners waiting for liver biopsy. On an intention to treat basis, 45 prisoners (52%) achieved sustained virological response 6 months after the end of therapy. We conclude that a stay in prison is an effective opportunity to treat a group of hepatitis C patients which otherwise have very limited access to therapy.

Seroepidemiologic study of hepatitis B virus, hepatitis C virus, human immunodeficiency virus and syphilis infections in Iranian blood donors

To determine the frequency of hepatitis B, hepatitis C, Human Immunodeficiency Virus (HIV) and syphilis infections in Iranian blood donors. The prevalence of serological markers of hepatitis B, hepatitis C, HIV and syphilis infections were evaluated in 318029 consecutive volunteer blood donors attending to Tehran blood transfusion service from March 2005 to March 2006. Those positive for hepatitis B surface antigen, anti-HCV, anti-HIV1/2 and VDRL (venereal disease research laboratory) reactivity were analyzed with a second independent HBsAg enzyme immunoassay (EIA) and neutralization assay; an additional independent anti-HCV EIA and HCV-RIBA assay; second independent anti-HIV1/2 test, HIV western blot and fluorescent Treponemal Antibody Absorbed (FTA-ABS), respectively. In 318029 participants, prevalence of positive HBsAg, HCV RNA, HIV western blot and FTA-ABS was 1684 (0.487%), 323 (0.093%), 11 (0.003%) and 19 (0.005%), respectively. In 1014 subjects randomly selected from these 318029 participants, besides standard interview, physical exam and routine serologic tests; anthropometric and biochemical were studies. In this selected group frequency of HBsAg was 3 (0.29, 95% CI: 0-0.64%); frequency of anti-HCV was 21 (2.07%), but it was (0.09%, 95% CI: 0-0.30%) by confirmatory HCV RNA test; frequency of HIV-Abl, 2 was 8 (0.78%), but it was 2 (0.19%, 95% CI: 0-0.48%) by confirmatory test; frequency of RPR was 0 (0%, 95% CI: 0-0.30%). Despite excluding subjects with high-risk behaviors by standard interview and physical examination, still a few asymptomatic hepatitis B, hepatitis C, HIV-infected subjects existed among volunteer blood donors with demographic and biochemical findings similar to non-infected ones.

The prevalence of hepatitis B, hepatitis C and HIV infections in non-IV drug opioid poisoned patients in Tehran-Iran

The present study intends to look into the prevalence of these infections in the non-IVdrug abusing addicts whom were treated at our center. A pilot study was conducted on 20 patients who were admitted in poisoning center of Loghman-Hakim Hospital in Tehran due to non-IV drug overdose. One positive HIV antibody and one positive HBS antigen cases were found in this group. The pilot study was later expanded to a descriptive cross-sectional study on 214 patients. In this study 196 patients (91.6%) were male and 18 (8.4%) were female. The average age of subjects was 37.9, having the highest frequency between 20 to 30-years-old. The study showed that 14.48% (F = 31) had positive HCV antibody and 1.86% (F = 4) had positive HBS antigen and 1.4% (F = 3) had positive HIV antibody in their blood serum. One hundred and forty three patients (66.8%), were poisoned through oral opium consumption, 24 patients (11.2%) through inhalation and 18 (8.4%) both oral and inhalation. The remain; were IV-abuser or the manner of poisoning was unknown. This study signifies the need for heightened attention and preventive measures against the infection of the health care professionals by hepatitis C (HCV) virus.

Buprenorphine Use: The International Experience

The confluence of the heroin injection epidemic and the human immunodeficiency virus (HIV) infection epidemic has increased the call for expanded access to effective treatments for both conditions. Buprenorphine and methadone are now listed on the World Health Organization's Model Essential Drugs List. In France, which has the most extensive experience, buprenorphine has been associated with a dramatic decrease in deaths due to overdose, and buprenorphine diversion appears to be associated with inadequate dosage, social vulnerability, and prescriptions from multiple providers. Other treatment models (in the United States, Australia, Germany, and Italy) and buprenorphine use in specific populations are also reviewed in the present article. In countries experiencing a dual epidemic of heroin use and HIV infection, such as former states of the Soviet Union and other eastern European and Asian countries, access to buprenorphine and methadone may be one potential tool for reducing the spread of HIV infection among injection drug users and for better engaging them in medical care.

[Hepatitis C in prison settings: screening and therapy are improving. Comparative survey between 2000 and 2003]

OBJECTIVE

To determine the real frequency of hepatitis C (HCV) in French prisons.

AIMS AND METHODS

To evaluate the changes in HCV screening and therapeutic practices in prisons between 2000 and 2003 by comparing results of mail surveys of prison medical units both years (* if p<0.01).

RESULTS

88 units (51%) responded to both surveys. In 2003, HCV serologic screening was routinely performed in 28% (36%* in 2000) of prisons and routinely offered in 66% (35%*). Mean HCV prevalence was 6.9% in 2003 and 6.7% in 2003. There were 534 liver biopsies in 2003 and 545 in 2003, that is, an average of 6 biopsies per unit per year both years. Treatment was provided to 297 patients in 2003 and 164 in 2000, but 29% of prisons offered no treatment in 2003, and 44% (*) in 2000. Overall 14% of HCV-infected prisoners received therapy.

CONCLUSION

The prisons participating in this study and the inmates they include were representative of the French prison population. HCV prevalence in French prisons appears stable. Routinely suggested or conducted screening is widespread. The number of liver biopsies is stable but low, and the number of patients receiving treatment has increased significantly.

Prevalence of hepatitis C virus infection and its related risk factors in drug abuser prisoners in Hamedan - Iran

AIM: Recent studies in Iran has shown that prevalence of hepatitis C virus (HCV) infection among Iranian prisoners is high, in spite of low HCV seroprevalence in general population.

METHODS: This study was carried out in the central prison of Hamedan - Iran, in year 2002. Inmates were interviewed using a standard questionnaire including demographic, imprisonment history and HCV-related risk behaviors items. Thereafter, the sera drawn from the participants were tested for anti-HIV and anti-HCV antibodies.

RESULTS: A total number of 427 drug abuser inmates participated in our study. Three hundred and ninety-seven (93%) were men and 30 (7%) were women. Total number of IV drug abusers (IDA) and non-IV drug abusers (NIDA) was 149 (34.9%) and 278 (65.1%), respectively. The overall rate of antibody positivity among inmates was 0.9% for HIV and 30% for HCV. Of all IDAs, 31.5% and of NIDAs, 29.1% had serological evidence of HCV infection.

CONCLUSION: The seroprevalence of HCV infection among drug abuser prisoners in comparison with the general population in Iran, is very high (30% vs in italics 0.2%). Our results indicate the importance of policies to prevent transmission of HCV infection during and following incarceration.

[Evolution of strategy and coverage rates for hepatitis B vaccination in France, a country with low endemicity]

Both HBV plasma derived vaccines and HBV recombinant vaccines have proved safe and highly immunogenic. In France, exhaustive population surveys have revealed a vaccine coverage rate of over 21.7% and very low three-dose vaccine coverage among infants (19.8%), children (23.3%), and adolescents. Among hospital staff, around 80 to 90% of physicians and health care personnel in public or private hospitals were vaccinated against hepatitis B and the level of coverage was higher among personnel accidentally exposed to blood (90 to 100%). Among risk groups, the specific prevention program against mother-infant transmission was unevenly applied, and between 25 to 45% of intravenous drug abusers, prisoners, or STD patients were vaccinated. These coverage rates are inadequate to obtain a significant reduction and control of hepatitis B infections in France. The complete eradication of HBV transmission might take another 20 years to achieve unless great efforts are made to vaccinate the general population (infants especially) and high-risk groups.