Denying Hepatitis-C Cure to Incarcerated People and the Risk to Public HealthFebruary 04, 2019

About 97 percent of incarcerated people with hepatitis C – the most deadly infectious disease in the United States – have not received treatment, the Nation reports.

The failure to treat people in prisons, where an estimated 20 percent of incarcerated people carry the virus, risks making the nationwide epidemic worse, according to the report.

"A huge concentration of people who have it are [incarcerated], and if we don't cure people in prison, then they’ll be released and it will make it more prevalent on the outside of prison,” Mandy Altman, director of the National Hepatitis Corrections Network, told the Nation.

Hepatitis C, caused by a virus that infects and inflames the liver, kills around 20,000 Americans each year, which is more than the next 60 infectious diseases combined.

The Food and Drug Administration began approving direct-acting antiviral (DAA) drugs in 2011, which have a more than 95 percent success rate in curing hepatitis C, few side effects, and require as little as one pill a day for eight to 12 weeks. At $20,000 per patient on average, treatment costs are high, but those prices are dropping rapidly.

Guidelines set by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recommend early treatment for chronic hepatitis C in nearly all cases. But the Nation reports that fewer than 5 percent of incarcerated people with chronic hepatitis C have been given treatment.

Many state corrections departments limit treatment to people who suffer from severe complications, causing unnecessary suffering. "No one sentenced people in prison to die from lack of medical care," ACLU of Connecticut's legal director Dan Barrett told the Nation. "No gavel banged and said, 'I sentence you to a hole in which your medical needs are going to be ignored.'"

North Carolina, like Connecticut and other states, requires evidence of liver scarring before it will provide DAA's to incarcerated people. According to the Nation, it goes even further by barring from treatment people with a history of mental illness, fewer than 12 months left on their sentence, a life expectancy of less than 10 years and/or a disciplinary infraction for drugs or alcohol.

Lawsuits in North Carolina, Connecticut, Pennsylvania, Massachusetts, Colorado, Florida, and Missouri have challenged restrictions on hep-C treatment for incarcerated people, the report says, and settlements in several states have committed corrections officials to expanding access to the cure.

Still, as Michele Luecking-Sunman of North Carolina Prisoner Legal Services, told the Nation, "There are thousands of people in our prison system who have hepatitis C who don't know it."

Only a simple blood test is required to diagnose hepatitis C, and the Federal Bureau of Prisons and AASLD/IDSA recommend that prisons implement universal testing, which could save more than 11,000 lives over the next three decades.

Health officials told the Nation that screening and treating people in prison is "a golden opportunity to try to contain the epidemic, identify cases, and treat them, and, at the same time, help to stem the spread of the infection" nationwide. 

Ms. Altman from the National Hepatitis Corrections Network said it's a mistake to treat the prison population as separate from the general population. "There's no difference between people in prison's health and the health of our country. It's the same people."