Updated Guidance from the Federal Bureau of Prisons on Managing Hepatitis C In Federal Prisons

In October 2016, the Federal Bureau of Prisons (FBOP) released an update to their clinical practice guidelines for the Evaluation and Management of Chronic Hepatitis C Virus (HCV) Infection for the federal inmate population. The prevalence of hepatitis C infection among incarcerated persons is higher than in the general U.S. population and approximately 30% of persons living with hepatitis C infection will pass through correctional systems in a given year. Routine testing of inmates for hepatitis C and linking them to curative therapies can improve health outcomes, as well as prevent ongoing transmission, both within corrections and in the community upon release.
Below is a summary of major changes to the guidelines.

Screening and Treatment Initiation

• Opt-out hepatitis C testing is recommended for all sentenced inmates during the prevention baseline visit.
• Criteria for three priority levels (high, intermediate, and low) have been revised and condensed to facilitate prioritization of incarcerated persons for hepatitis C treatment to ensure that those with the greatest need are treated first.
• Pretreatment patient education—rather than informed consent—is now recommended for topics including (but not limited to): how to take the medication, the importance of adherence, monitoring and follow up, and potential medication side effects.
• For individuals infected with both hepatitis B and hepatitis C
  • If the criteria for hepatitis B treatment are met, initiation of hepatitis B treatment prior to or at the same time as hepatitis C treatment is recommended.
  • If the criteria for hepatitis B treatment are not met, monitoring hepatitis B virus DNA levels monthly during hepatitis C treatment is recommended.

Hepatitis C Treatment Options

• The recommended treatment regimens have been updated to include newly approved therapies and pegylated interferon has been eliminated from all recommended and alternative regimens except for some patients with renal impairment and an urgent need for treatment.

The FBOP guidelines also recommend review of the most recent information provided by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA). The most recent versions of the FBOP’s Clinical Practice Guidelines are available online.