In a retrospective, integrated analysis, the treatment regimen of sofosbuvir/velpatasvir (SOF/VEL) once daily for 12 weeks was found to be effective in eliciting a sustained virological response (SVR) in the prison population with hepatitis C virus (HCV) infection.¹ The study presented supportive evidence of using this simple regime across a broad range of HCV patients and across various settings with minimal monitoring requirements.¹

The prison population is often at a higher risk of mental illnesses and infectious diseases, possibly due to shortcomings in treatment and aftercare provision, as well as behavioral factors such as higher rates of intravenous drug use.² In particular, prisoners are at a higher risk of contracting HCV, with an estimated prevalence of 15.1%.³ In 2016, the World Health Organization (WHO) set out the goal of eliminating viral hepatitis by 2030, including HCV.⁴ However, this goal is more challenging in prison setting due to the lower healthcare engagement, with coronavirus disease 2019 (COVID-19) pandemic further compounding its difficulty in disease management.^5,6 Hence, the availability of a simplified treatment algorithm without the need of pre-treatment genotyping and subtyping is critical.⁵ The European Association for the Study of the Liver (EASL) guidelines recommend the use of pan-genotypic direct-acting antivirals (DAAs), such as SOF/VEL, for streamlining healthcare pathway and improving access to treatment.¹

The efficacy of SOF/VEL in prison setting has been demonstrated in a recent real-world analysis, which included patient-level data from 20 prisons in Belgium, Canada, France, Italy, Portugal, and Spain.¹ Enrolled patients (n=526) were those who had been infected with HCV genotypes 1-6, with or without compensated cirrhosis, and were treated with the oral single-tablet regimen of SOF/VEL 400/100mg once daily for 12 weeks without ribavirin.¹ The study’s primary outcome was SVR.¹

A total of 442 patients were included in the effectiveness population, with 98.9% of them (437/442) achieving SVR.¹ The rates of SVR were consistent across HCV genotypes (≥98.5%) and fibrosis stages (≥95.4%).¹ The favorable outcomes could be attributed to the high rate of patient’s adherence to the prescribed treatment in the effectiveness population, with 99.3% of patients achieving an adherence rate of ≥90%.¹ Among them, only 1 failed to achieve SVR.¹

In conclusion, the SOF/VEL treatment for 12 weeks among the prison population resulted in high rates of SVR irrespective of baseline characteristics, confirming its high effectiveness in the prison setting.¹ Besides, the high rates of adherence and the low rates of discontinuation reflected a favorable safety and tolerability profile of SOF/VEL.¹ This study supported SOF/VEL as a viable treatment regimen that provides a simplified treatment algorithm in line with the guideline recommendations to a broad range of HCV patients who do not have access to testing.¹ The adoption of SOF/VEL in various settings is likely to help reduce the prevalence of HCV infection not only in prisons, but also in the wider community, contributing to the WHO’s goal of eliminating viral hepatitis by 2030.¹