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Home > Estimating the seroprevalence of untreated chronic HCV infection in Mountjoy Prison.

Millar, Sean (2020) Estimating the seroprevalence of untreated chronic HCV infection in Mountjoy Prison. Drugnet Ireland , Issue 75, Autumn 2020 , p. 19.

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Background and methods

Unsafe injecting drug use is the main route of hepatitis C virus (HCV) transmission in developed countries,1 and it is generally acknowledged that people who inject drugs (PWID) and HCV infection are typically over-represented in prison populations across Europe.2 A 2016 meta-analysis reported a prison HCV prevalence in Western Europe of 15.5%, with this prevalence increasing to over 40% among those prisoners with a history of injecting drug use (IDU).3 However, the prevalence of HCV infection among prisoners in Ireland remains poorly understood. In addition, most epidemiological studies among PWID and prisoners report on HCV antibody prevalence (exposure) and not the presence of HCV RNA. Thus, they do not differentiate between treated chronic infection with sustained viral response (SVR) and the 20–30% of HCV-infected people who spontaneously clear HCV without treatment. A recent study aimed to estimate the seroprevalence of untreated chronic HCV infection and to identify associated risk factors in an Irish male prison population.4 

In this research, published in the journal Eurosurveillance, the authors conducted a cross-sectional study in Mountjoy Prison, Dublin involving a researcher-administered questionnaire, review of medical records, and HCV serology. All prisoners were offered screening for blood-borne viruses, including reflex RNA testing and genotyping. 

Results

Of the 422 prisoners (78% of the study population) who participated in the study, 298 (70.6%) completed the questionnaire and 403 (95.5%) were tested for HCV antibodies. Of those tested, 92 (22.8%) were HCV antibody-positive. Of those antibody-positive, 53 (57.6%) were HCV RNA-positive; 23 (25%) had spontaneous clearance; 16 (17.4%) had a SVR; 10 (11%) were co-infected with HIV and 6 (6%) with hepatitis B virus. The untreated chronic HCV seroprevalence estimate was 13.1% and the seroprevalence of HCV among prisoners with a history of IDU was 79.7%. 

Risk factors significantly associated with past HCV infection were IDU (p<0.0001); having received a prison tattoo (p<0.0001) or a non-sterile community tattoo (p<0.0001); and sharing needles and other drug-taking paraphernalia (p<0.0001). On multivariable analysis, history of receiving a non-sterile community tattoo was the only significant risk factor associated with HCV acquisition (after IDU was removed from the model) (p=0.005). 

Conclusions

The authors concluded that the level of untreated chronic HCV infection in Irish prisons is high, with IDU being the main associated risk. The reporting of HCV infection in prisoners in this way is unique in both the Irish and international literature and allows for the estimation of the true levels of active HCV infection, the monitoring of treatment outcomes, and rates of reinfection. Identifying risk factors for HCV infection may allow for targeted prevention, screening, and treatment strategies. Combined, these may help to inform planning and implementation of national and international HCV strategies.

 

1 Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, et al. (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet, 378(9791): 571–583. https://www.drugsandalcohol.ie/15845/

2 Larney S, Kopinski H, Beckwith CG, Zaller ND, Jarlais DD, Hagan H, et al. (2013) Incidence and prevalence of hepatitis C in prisons and other closed settings: results of a systematic review and meta-analysis. Hepatology, 58(4): 1215–1224.

3 Dolan K, Wirtz AL, Moazen B, Ndeffo-Mbah M, Galvani A, Kinner SA, et al. (2016) Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees. Lancet, 388(10049): 1089–1102. https://www.drugsandalcohol.ie/25800/

4 Crowley D, Lambert JS, Betts-Symonds G, et al. (2019) The seroprevalence of untreated chronic hepatitis C virus (HCV) infection and associated risk factors in male Irish prisoners: a cross-sectional study, 2017. Euro Surveill, 24(14): 1800369. https://www.drugsandalcohol.ie/31182/

5 Cloverhill Visiting Committee (2020) Annual report 2018 from Cloverhill Visiting Committee to the Minister for Justice and Equality Charles Flanagan TD. Dublin: Department of Justice and Equality. https://www.drugsandalcohol.ie/32084/

6 Arbour Hill Visiting Committee (2020) Arbour Hill Prison Visiting Committee annual report 2018. Dublin: Department of Justice and Equality. https://www.drugsandalcohol.ie/32084/

7 Shelton Abbey Visiting Committee (2020) Visiting Committee annual report 2018: Shelton Abbey. Dublin: Department of Justice and Equality. https://www.drugsandalcohol.ie/32084/

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