Does a patient with hepatitis B (HBV) on treatment, such as tenofovir (tenofovir disoproxil fumarate) or entecavir, need to be housed alone in a corrections facility?

Housing for Hepatitis B Patients on Treatment in Correctional Facilities

Patients with hepatitis B on treatment such as tenofovir or entecavir do not need to be housed alone in correctional facilities. Standard infection control precautions are sufficient to prevent transmission in this setting 1.

Rationale for Shared Housing

Hepatitis B virus (HBV) is transmitted through:

• Blood exposure
• Sexual contact
• Perinatal transmission

The CDC guidelines for correctional facilities specifically address management of HBV-infected inmates and do not recommend isolation. Instead, they emphasize:

1. Standard precautions: Universal precautions for blood and body fluids should be implemented for all inmates regardless of infection status 1.

2. Education and counseling: Inmates with chronic HBV should receive counseling on preventing transmission to contacts, including risk reduction and safe sex practices 1.

3. Vaccination of contacts: Close contacts, including cellmates, should be vaccinated against hepatitis B 1.

Management Recommendations for HBV-Infected Inmates

Medical Evaluation

• Inmates identified with chronic HBV infection should be evaluated to determine:
  • Extent of liver disease (ALT, AST, albumin, prothrombin time)
  • Status of viral replication (HBeAg, anti-HBe, HBV DNA)
  • Potential benefit of antiviral therapy 1

Treatment Considerations

• Antiviral medications like tenofovir and entecavir effectively suppress viral replication
• Treatment reduces but does not eliminate risk of transmission
• Treatment decisions should be made in consultation with specialists experienced in HBV management 1

Prevention Measures

• Vaccination: Offer hepatitis B vaccination to all susceptible inmates, especially those sharing housing with HBV-infected individuals 1, 2
• Education: Provide comprehensive education about transmission routes and prevention methods 1
• Contact tracing: Identify and test close contacts of infected individuals 1, 3, 4

Evidence of Transmission Risk in Correctional Settings

Several outbreaks of hepatitis B have been documented in correctional facilities, primarily associated with:

• Unprotected sexual activity between inmates 3
• Sharing of injection equipment 4
• Tattooing with contaminated equipment

However, these outbreaks occurred primarily among unvaccinated individuals and those not on treatment 3, 4.

Important Considerations

1. Antiviral therapy reduces transmission risk: Patients on effective treatment like tenofovir or entecavir typically have suppressed viral loads, significantly reducing (though not eliminating) transmission risk.

2. Vaccination is key: The most effective prevention strategy is vaccination of all susceptible inmates, especially those in close contact with HBV-infected individuals 1, 2.

3. Standard precautions are sufficient: When proper infection control procedures are followed, the risk of HBV transmission in shared housing is minimal 1.

4. Avoid stigmatization: Isolating HBV-infected inmates can lead to stigmatization and may discourage testing and treatment 5.

Conclusion

Rather than isolation, correctional facilities should focus on:

• Implementing standard infection control precautions
• Providing hepatitis B vaccination to susceptible inmates
• Ensuring appropriate medical evaluation and treatment for infected individuals
• Educating all inmates about prevention of bloodborne infections

This approach balances public health concerns with the rights and well-being of infected individuals while effectively preventing HBV transmission within correctional facilities.