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In Canada, we are still awaiting the kind of hepatitis C treatment now recommended for federal prisoners in the USA! New guidelines were just released in May 2014 and are available here: http://www.bop.gov/resources/pdfs/hepatitis_c_current.pdf These are the recommended treatments for federal prisoners with chronic hepatitis C, according to genotype (GT):
GT1: PREVIOUS NON-RESPONDER (partial or null) TO INTERFERON TREATMENT or INTERFERON-INTOLERANT
combine Gilead’s sofosbuvir (SOVALDI) with Janssen’s simeprevir (GALEXOS in Canada, OLYSIO in USA) – either with or without ribavirin added – for 12 weeks.
GT1: TREATMENT-NAIVE INDIVIDUALS WITH SIGNIFICANT LIVER DAMAGE or INTERFERON TREATMENT RELAPSER or THOSE WHO’VE NOT RESPONDED TO PREVIOUS TREATMENT WITH A PROTEASE INHIBITOR
first try a cocktail of sofosbuvir + peginterferon + ribavirin for 12 weeks. Do not even bother trying to treat with boceprevir or telaprevir. They also advise, “If peginterferon is contraindicated, consider sofosbuvir + simeprevir – either with or without ribavirin added – for 12 weeks.”
GT2:
sofosbuvir + ribavirin for 12 weeks.
GT3:
sofosbuvir + ribavirin for 24 weeks.
GT4:
sofosbuvir + ribavirin + peginterferon for 12 weeks. If interferon contraindicated: sofosbuvir + ribavirin for 24 weeks.
GT5 or GT6:
sofosbuvir + ribavirin + peginterferon for 12 weeks.
THOSE WHOSE DISEASE IS NOT VERY ADVANCED
put off treatment for now and await the superior interferon-free treatments coming down the line: “it is reasonable to postpone treatment for cases with less advanced fibrosis, pending the expected availability of better treatments in the very near future.”
LIVER DAMAGE TESTS
These guidelines also recommend using non-invasive means of determining the stage of liver damage, such as APRI. The formula used by BOP (Bureau of Prisons) is: s [(AST/AST ULN) x 100/(platelet count x 103/μL/ 1,000)] NOTE: ULN means Upper Limit of Normal, and AST ULN varies according to gender – consult doctor. “The BOP will prioritize for treatment inmates who have an APRI score≥1.0, or whose APRI score is between 0.7 and 1.0 along with other findings suggestive of advanced fibrosis (low albumin or platelets, elevated bilirubin or INR).”
PRIORITY GIVEN TO THOSE WITH:
Advanced hepatic fibrosis/cirrhosis
Liver transplant recipients
HIV co-infection
Comorbid medical conditions associated with HCV, e.g. cryoglobulinemia and certain types of lymphomas
Continuity of care for newly incarcerated BOP inmates who were being treated at the time of incarceration