Hepatitis Patients in Prisons

Innovative Insights from Working with Hepatitis Patients in Prisons BY Dr Sudasheka Perera, HMP Bronzefield

Consideration of Hepatitis B infection amongst our prison patient cohort is important for many reasons. Prisoners are considered high risk for being or becoming infected with hepatitis B due to them being more likely to engage in high risk activities such as unprotected sexual activity and injecting drugs. Furthermore, we have a lot of prisoners from high risk countries and chronic hepatitis B infection amongst migrants to the UK accounts for 96% of all new cases of chronic hepatitis B in the UK.

Hepatitis B can be transmitted through exposure to infected blood (concentration is higher) and body fluids. The 4 major modes of transmission are:

• Mother to child at birth (the most common route of transmission amongst our migrant patients)
• Blood to blood contact
• Sexual contact (vaginal, anal and oral sex, risk is higher amongst men who have sex with men)
• Iatrogenic transmission e.g. haemodialysis, sharps injury, blood or blood products transfusion etc.

All prisoners, when them come into prison, should be tested for Hepatitis B. But do we know how to interpret the blood test results? Here is a quick guide:

• Hep B surface antigen = if positive the patient has infectious hepatitis B and need referral to infectious diseases
• Hep B e antigen positive = patient has hep B infection with high replication and high infectivity
• Hep B e antibody positive = patient has hep B infection but they they have cleared the e antigen, hence they have low replication and low infectivity
• Hep B core antibody positive:
  • If Hep b surface antigen is also positive = current infection:
    • Hep B core IgM positive = infected within last 6 months
    • Hep B core IgG positive = infected more than 6 months ago
  • If Hep B surface antigen is negative = previous infection which has been cleared
• Hep B surface antibody positive = lifelong immunity either from vaccination or clearance of infection
• Hep B DNA = used to guide treatment and indicate risk of progression to complications e.g. cirrhosis and hepatocellular carcinoma (HCC)

If a patient is found to have hepatitis B infection other blood tests to check are LFTs, FBC, clotting as these can help determine progression of disease and also help guide treatment. Patients should also be tested for hepatitis A, C, delta, and HIV because co-infection is common and also because co-infection means higher risk of progression of hepatitis B infection to cirrhosis and HCC.

Treatment will vary depending on the blood test results. This should follow local guidance and pathways.