By Christopher anderson
WASHINGTON – Maryland prison and health officials say a looming hepatitis C epidemic will be a bigger, and potentially more expensive, health crisis than HIV and AIDS, but they still do not have a comprehensive policy in place to address it.
Officials admit that they do not yet have an accurate account of the number of inmates infected with hepatitis C. But its close association with HIV and the experiences of states with similar prison populations leads them to believe hepatitis C could be more expensive than HIV.
Maryland had the second-highest rate of HIV infection among prison inmates in the nation in 2000, according to a recent Justice Department report.
The state cannot, by law, require that prisoners be tested for either virus, so exact numbers are not available. But the results of a double-blind study that anonymously tested more than 3,000 inmates for both HIV and hepatitis C will be available soon.
Until then, the state is forced to work with estimates based on other states’ infection rates.
Pennsylvania has a slightly larger prison population than Maryland, but roughly the same number of HIV-infected inmates. When it made hepatitis-C testing available to all inmates, it found that about 17 percent, or 6,200, of its prisoners were infected.
Treatment for those prisoners is costing Pennsylvania nearly $8 million, according to some reports.
“If you think HIV is expensive, the care of hepatitis C is very costly,” said Dr. Tony Swetz, director of inmate health for Maryland’s prisons. He estimated that costs for hepatitis-C treatment range from $12,000 to $20,000 per patient or more.
Maryland already spends $1,500 to $15,000 per inmate on treatment for HIV.
About 1,000 inmates, or 4.3 percent of the state’s prisoners, were HIV- positive in 2000, according to the most recent statistics from the Department of Justice. That number was twice the national average.
The standard treatments for hepatitis C, called interferon and ribavirin, can prevent the effects of the disease — liver damage, liver cancer and cirrhosis — in some cases.
But the treatment regimens can take more than a year to complete, and because they are not effective in all cases, tests must be done to determine if the infected individual can be treated. Those tests add several hundred dollars to the cost of treatment, said Dr. Sharon Baucom, medical director for the Department of Public Safety and Correctional Services.
Baucom is leading of a task force to create the state’s new policy for testing or treating inmates for hepatitis C. She said she is looking at how other federal and state prison systems handle the problem. The challenge, she said, is finding a treatment policy that is both “clinically effective and cost effective.”
“The average sentence length in Maryland is about 29 months,” Swetz said, making it unlikely that many inmates would be in the system long enough to complete treatment for the disease.
Because drug addiction is the No. 1 risk factor for most of Maryland’s prisoners, it must be addressed as part of any successful treatment for HIV and hepatitis C, to help inmates once they are out of prison, officials said. Forty percent of inmates admit they are injection-drug users when they are brought into the system, Swetz said.
Some state prison systems require prisoners to complete drug rehabilitation before beginning treatment for hepatitis C. But one of the side- effects of interferon treatment is depression, which can contribute to the chances a prisoner will relapse into drug use.
“If you invest $12,000 to prevent liver problems down the road and they relapse and begin drug use again, they could potentially reinfect tthemselves,” Swetz said. “The taxpayers would have expended a significant amount of money to somebody who’s not going to benefit from it.”
And, he adds, “we are setting ourselves up for more drug resistance” by the virus that causes hepatitis C.
Currently the state does not provide interferon or ribavirin treatment, except for inmates who began treatment before incarceration. Only a handful of inmates are currently receiving treatment for the disease, Baucom said.
Maryland also does not provide voluntary testing for hepatitis C, as it does for HIV. Prisoners who are HIV-positive are tested for hepatitis C, however, and about 55 percent of them are found to be infected with both.
Prison officials say they are not surprised by the high infection rates, since Maryland has always had high HIV and AIDS infection rates among its general population, especially in high-crime, urban areas like Baltimore.
“It’s the population we deal with,” Swetz said. “About 80 percent of the people that walk through our front doors have significant substance abuse problems.
“Baltimore has always had the singular distinction of being the heroin capital of the country,” he said.
Baucom recognizes that, as with HIV, successful treatment programs for hepatitis C may begin in prisons, but will continue even after release for most prisoners affected by the disease.
“It can’t be a decision with Maryland corrections alone,” Baucom said. “We have to work very closely with what the state health department can offer the citizens.”