The Society of Correctional Physicians (SCP) held its semiannual meeting in Baltimore, Maryland, on April 10. The theme, Correctional Care of Infectious Diseases and Mental Health Issues, attracted experts willing to share recent developments with the audience of correctional physicians. In the field of infectious disorders, contributions were given by Drs. David Williamson of the C. T. Perkins Hospital Center, David L. Thomas of Johns Hopkins, Jay Hoofnagle of the National Institutes of Health, Glenn Treisman of Johns Hopkins, and others.

Dr. Thomas emphasized the importance of HBeAg testing of all patients with chronic hepatitis B virus (HBV). Patients with negative HBeAg tests and normal ALT levels are "healthy carriers," he said. Indications for interferon treatment include persistently elevated ALT levels (over twice the normal level), abnormal liver histology, and absence of end-stage liver disease. Sustained responders ("cures") will have no evidence of HBeAg, will show corresponding antibodies (Anti-HBe), and ALT normalization.

Dr. Hoofnagle described a new understanding of the natural history of chronic hepatitis C (HCV) infection. In the absence of HIV coinfection, HCV may take up to 50 years to evolve into fatal end-stage liver disease or hepatocellular carcinoma (HCC). HCV progression is marked by development of liver fibrosis, as measured by Stages 1-4 liver histology. Because therapies are constantly being improved, Hoofnagle stated that it might be prudent to wait for better therapies for patients with early stages of fibrosis. Otherwise, he said, a treatment failure may result and patients may not respond to retreatment with future therapies. Dr. Hoofnagle also showed his recent compilation of end-of-follow-up "cure" results for white and African American persons. Although the number of African American patients treated was small, a disturbing and unexplained lowered response rate was noted. The significance of this difference is not yet known.

Dr. Williamson described common psychiatric complications of HIV disease. He distinguished patients who can be safely treated by primary care physicians from those who may need psychiatric evaluation and follow-up. Lastly, Dr. Treisman reviewed mental health approaches to patients with HIV infection and other conditions. He emphasized the difficulty for psychiatrists to understand the motivations and social situation of the inmates that they treat. These barriers may result in a relative inability to achieve substantial patient rapport and therefore, less success in helping these patients.

* Nothing to disclose

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©1997,1998,1999,2000,2001,2002, 2003. The recently formed HIV Education Prison Project (HEPP) is a medical education program that targets a growing population, inmates in correctional facilities, that has been underserved in HIV care. It is part of the Brown University AIDS Program. Permission to use and reproduce portions of this newsletter is hereby granted provided that author and publication are fully credited and both copyright and permission notice appear with reprinted material. Inquiries may be directed to heppnews@brown.edu. Website: HIV Education Prison Project.

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