Dear Colleagues:

I am reminded of the problems addressed in this issue of the HEPP Report every time I visit the inpatient ward of my facility. Several of our ID clinic patients have become long-term residents of that ward, simply because their liver disease cannot be safely managed in the outpatient correctional setting. I have had to revisit published literature in order to learn to manage these patients more effectively. This issue of HEPP Report was conceived with that need for an update in mind ­ we’ve now provided you (and me!) with the latest information on the management of inmates presenting with chronic hepatitis and cirrhosis.

Unfortunately, HCV-related liver disease is only likely to become even more common in correctional settings as time goes on. While the incidence of HCV (the rate of new infections) is slowly decreasing, HCV-related liver disease is becoming more common as HCV infections "mature". The prevalence of HCV-related liver disease is expected to peak in the year 2010 both inside and outside of correctional settings. Given the fact that the cost for hospitalizations related to HCV in the United States was 1.6 billion dollars in 1998, 10 to 12 years before the expected peak, it is clear that we are about to witness a major shift in prison health care expenditures.

Given that potential scenario, aggressive treatment of HCV-infected patients in correctional environments should be viewed as potentially cost saving. One decision analysis study has demonstrated that HCV treatment resulted in a net savings in the range of $400 to $3500 over the lifetime of each patient, in the same range of cost effectiveness as stool guiac testing, pneumococcal vaccination, coronary bypass surgery, and mammography. According to a more recent publication, combination HCV therapy resulted in improvements in Quality Adjusted Life Year (QALY) for both men and women. QALY measures improvements in health-related quality of life, meaning less chronic illness and fewer laboratory tests and clinic visits. These are the same types of benefits that have been observed over the past 10 years following improvements in HIV care. More aggressive management of HCV infection in the near term may therefore affect the "bottom line" for correctional health care in years to come.

My visits to the inpatient ward in my facility hint at our collective future. We anticipate that this issue of HEPP Report will provide you with an overview of prevention, diagnosis and treatment of viral hepatitis and cirrhosis, and approaches that may be efficacious in preventing common complications of end-stage liver disease.

And let us not forget to celebrate the season! The entire staff of HEPP Report wishes you a wonderful holiday and a happy and healthy 2004!

Sincerely,
Annie De Groot, M.D,
Co-chief Editor, HEPP Report

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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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