Deadly Liver Disease Lurks Behind Bars

Deadly Liver Disease Lurks Behind Bars
Posted by FoM on October 19, 1999 at 15:23:45 PT
By Kathleen Fackelmann, USA TODAY 
Source: USA Today
An estimated 4 million people, or 1.8% of all Americans, have a time bomb called hepatitis C lurking in their blood.But go to any prison in the USA and the rate of the sometimes lethal infection begins to soar.
Public-health experts estimate that 20% to 60% of the 2 million people locked up on any given day are infected with the liver-damaging virus."The seriousness of this is not fully understood," says Alan Brownstein, president of the New York-based American Liver Foundation. Infected people who leave prison can and will pass this virus to others, experts say.Indeed, the nation's prisons and jails act as incubators for infectious diseases, such as HIV (the AIDS virus), tuberculosis and syphilis, says Theodore Hammett, a researcher at the health policy firm of Abt Associates in Cambridge, Mass.Hammett's research indicates that as many as 1.4 million people released from prisons and jails in 1996, the most recent year for which statistics are available, were infected with hepatitis C. That represents about one-third of all those infected in the nation, he says.Prison officials are starting to offer treatment for HIV infection, tuberculosis and other diseases but in most cases have balked at the high cost of treating prisoners with hepatitis C, says Jackie Walker of the National Prison Project of the American Civil Liberties Union in Washington, D.C.But without treatment, some public health experts warn, prisoners could contribute to a wave of hepatitis C infections. Consider: An infected ex-con could have sex with (and pass the virus to) many partners after getting out of prison. Or a just-released prisoner might visit the dentist. If the dental staff doesn't properly clean the equipment, the next patient could get hepatitis C, Brownstein says."It's a threat to the general population," he says.But many state and local prisons look the other way, Brownstein says. In many cases, prisons neither test for the virus nor offer any treatment, he says.In addition to the public health threat, non-treatment can turn even a short prison sentence into a death sentence. Walker says prisons are obligated to provide such lifesaving treatment to prisoners.Hepatitis C is one of a family of viruses that can cause hepatitis or liver disease. About 85% of those who pick up the virus will go on to suffer a chronic infection. From 10 to 40 years after infection, the result can be liver failure and death.Some states just now are grappling with hepatitis C - and have uncovered just how frightening the problem has become.In a recent study of incoming Texas inmates, nearly 30% had hepatitis C infections - a number that translates to about 42,000 men and women, says David Smith, president of the Texas Tech University Health Sciences Center in Lubbock. Texas Tech, the University of Texas and the Texas De partment of Criminal Justice conducted the survey.Nobody knows why, but women were more likely to suffer from the infection. The study, not yet published, showed that about 28% of the male inmates and 37% of female inmates had the virus."We're concerned that hepatitis C is coming on us faster than AIDS did," says Glen Castlebury, a spokesman for the Texas Department of Criminal Justice. A similar study, published in the March (italic)Western Journal of Medicine(/italic), found that 41% of criminals entering California prisons had hepatitis C infection. Again, women (53.5%) were more likely to suffer from the infection than men (39.4%).Most of the other states have not looked for hepatitis C in prisons. But the high rates found in California and Texas are likely to be repeated across the nation, says Harold Margolis, chief of the hepatitis branch at the federal Centers for Disease Control and Prevention.But one of the formidable obstacles to curbing the disease is cost. Standard treatment runs about $10,000 per year per person, says Edward Harrison, president of the National Commission on Correctional Health Care in Chicago, a group with a mission to improve the quality of the health care in U.S. prisons. "It's a very expensive disease to treat," he says. Further, not everyone benefits from the two main drugs used to combat the virus, interferon and ribavirin, he says.Just 30% seem to get better with the pricey combo. And some get sick after treatment and require another round of drugs. Even worse, scientists don't know whether people who get better will stay that way.Those uncertainties have led many officials to withhold treatment on grounds there's no clear-cut benefit."States don't want to spend a lot of money on this," says David Thomas, a hepatitis C expert at Johns Hopkins University School of Medicine in Baltimore. Yet he and other experts now say drug therapy will push back the viral assault on the liver."We know we can cure some people with interferon and ribavirin," he says.And states that continue to take a see-no-evil approach to hepatitis C in prisons will get hit with a wave of deaths from end-stage liver disease, Thomas says. "People will die of liver failure in prisons," he says.Experts say many prisoners get infected with hepatitis C because they are intravenous drug users, a very efficient way to pass the virus. Studies suggest that 80% of IV drug users have hepatitis C, contracted when they share a needle tainted with blood. Adding another barrier, doctors - even those outside the prison system - won't treat a drug abuser who hasn't kicked the habit or is at risk of going back to drugs and getting infected with the virus again. Other ways to catch hepatitis C: a blood transfusion before 1992, the year the nation began rigorously screening blood for the virus; sex with many partners; and snorting cocaine through a shared straw.Prisoners with hepatitis C may have some unusual traits, such as a greater risk of IV drug abuse or the use of unsanitary tattoo parlors, but the truth is they represent just one part of the hepatitis C threat in America today."There are some boomer yuppies that got it at Woodstock," Thomas says. "But that's just the tip of the iceberg." Researchers know that veterans, particularly Vietnam veterans, are at higher risk of hepatitis C because they were exposed to blood on the battlefield, needed a transfusion or abused drugs. Beyond that group, people from all walks of life, from soccer moms to lawyers, can get the virus if they were among the boomers, for instance, who experimented with cocaine or shared a needle or a straw, Brownstein says. The CDC says about 12,000 people die annually in the USA of liver disease caused by the virus. By 2010 the annual death toll will exceed 38,000, the federal agency says.Public health officials say that by treating prisoners with hepatitis C, they have a unique opportunity to halt that dire outlook. Treatment of someone who is locked up for at least a year could stave off liver damage and the need for a liver transplant, Brownstein says. Even those who are not candidates for therapy could be given the information they need to slow the disease and prevent its spread, he says. For example, infected people could be told that sharing dirty needles or personal items such as a razor could pass the virus. They also could be told that alcohol speeds up the damage to the liver, Brownstein says."We are honor-bound to give people this information," he says.Public-health experts say the states should follow the federal government's lead. The federal prison system tests for hepatitis C infection if an inmate shows signs of the viral disease or has certain risk factors, such as a history of injecting drugs or a blood transfusion, says Newton Kendig , the medical director for the Federal Bureau of Prisons. The federal prison system, which houses mostly white-collar criminals, is thought to have a lower rate of hepatitis C than the state prison systems.If inmates show signs of liver damage and meet other treatment conditions, they will get treatment with ribavirin and interferon, Kendig says.The drug duo can help some patients but is not without side effects, including a flulike illness, rage, irritability and depression. Such side effects can derail treatment for an inmate already suffering from rage or depression, Kendig says.Although prison officials are beginning to realize the scope of the problem, few states seem willing to fund treatment that could run into billions.The issue of who will pay spills over into society as a whole, says Jonathan Fielding, hepatitis C expert at the University of California, Los Angeles. Fielding says many people with hepatitis C lack health insurance.Taxpayers could pick up much of the cost for treating the uninsured for hepatitis C, whether they're in prison or not.At least one study projects the need for liver transplants because of hepatitis C will triple during the coming decade. At $250,000 a pop, that's a price tag no one wants to shoulder.At the same time, experts say the USA can't afford to ignore hepatitis C in prisons.Although the rates of new hepatitis C infections have gone down recently, the high rates of the virus in prison represent a disease reservoir, one that could spill over its banks. "This is a major public health threat," Fielding says.SIDEBAR: Getting and treating disease Hepatitis is an inflammation that destroys patches of liver tissue. Details of hepatitis C:Symptoms. Often, there are none until liver damage occurs, but they can include flulike illness, fatigue, nausea, headaches and abdominal pain. Incubation period. It can be as long as 28 weeks but averages seven to nine weeks.Transmission. Blood-to-blood contact, especially by sharing needles in IV drug use; other exposure to items with contaminated blood, such as needles (tattoo, body-piercing or acupuncture), razors, nail files, toothbrushes, scissors and tampons; sexual transmission through rashes or sores; blood transfusions before July 1992. Treatment. Interferon or combination drug treatments. A liver transplant is needed for end-stage hepatitis C. Vaccines. None. Oct. 19, 1999  Copyright 1999 USA TODAY, a division of Gannett Co. Inc. 
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