Background/Aims Despite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore.
Methods In this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013–2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types.
Results A total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P<0.001) and lower treatment default rate (1% vs. 9%, P<0.001).
Conclusion In this large cohort of incarcerated HCV-infected patients, we demonstrated that unrestricted access to DAA is an impactful strategy to allow rapid treatment up-scale in HCV micro-elimination.
Citations
Citations to this article as recorded by
Editorial on “Direct-acting antiviral therapy for patients with HCV-related hepatocellular carcinoma: A nationwide cohort study” Yan Ling Ong, Apichat Kaewdech, Daniel Q Huang, Yu Jun Wong Clinical and Molecular Hepatology.2026; 32(1): 407. CrossRef
Hepatitis C elimination in Singapore: Current status and future directions JWE Quek, D Varun, JH Loo, KC Yew, J Hsiang, PH Thurairajah, C‐K Tan, R Kumar, YJ Wong Journal of Gastroenterology and Hepatology.2025; 40(1): 339. CrossRef
Status of hepatitis B virus and hepatitis C elimination in Singapore: a call for action Yu Jun Wong, Daniel Huang Singapore Medical Journal.2025; 66(7): 376. CrossRef
Elimination of chronic viral hepatitis C in correctional health Rahul Kumar, Yu Jun Wong, Jessica Tan Singapore Medical Journal.2025; 66(Suppl 1): S70. CrossRef
Global epidemiology, natural history, maternal-to-child transmission, and treatment with DAA of pregnant women with HCV: a systematic review and meta-analysis Joo Wei Ethan Quek, Jing Hong Loo, En Qi Lim, Ambrose Hon-Lam Chung, Abu Bakar Bin Othman, Jarell Jie-Rae Tan, Scott Barnett, Mindie H. Nguyen, Yu Jun Wong eClinicalMedicine.2024; 74: 102727. CrossRef
Liver diseases and hepatocellular carcinoma in the Asia-Pacific region: burden, trends, challenges and future directions Lung-Yi Mak, Ken Liu, Sakkarin Chirapongsathorn, Kuo Chao Yew, Nobuharu Tamaki, Ruveena Bhavani Rajaram, Mara Teresa Panlilio, Rashid Lui, Hye Won Lee, Jimmy Che-To Lai, Anand V. Kulkarni, Madhumita Premkumar, Cosmas Rinaldi Adithya Lesmana, Yao Chun Hsu, Nature Reviews Gastroenterology & Hepatology.2024; 21(12): 834. CrossRef
Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients Yu Jun Wong, Chen Zhaojin, Guilia Tosetti, Elisabetta Degasperi, Sanchit Sharma, Samagra Agarwal, Liu Chuan, Chan Yiong Huak, Li Jia, Qi Xiaolong, Anoop Saraya, Massimo Primignani Clinical and Molecular Hepatology.2023; 29(1): 135. CrossRef
Response to antiviral therapy for chronic hepatitis C and risk of hepatocellular carcinoma occurrence in Japan: a systematic review and meta-analysis of observational studies Yoko Yamagiwa, Keitaro Tanaka, Keitaro Matsuo, Keiko Wada, Yingsong Lin, Yumi Sugawara, Tetsuya Mizoue, Norie Sawada, Hidemi Takimoto, Hidemi Ito, Tetsuhisa Kitamura, Ritsu Sakata, Takashi Kimura, Shiori Tanaka, Manami Inoue, Sarah Krull Abe, Shuhei Nomur Scientific Reports.2023;[Epub] CrossRef
Access to Hepatitis C Treatment during and after Incarceration in New Jersey, United States: A Qualitative Study Samir Kamat, Sankeerth Kondapalli, Shumayl Syed, Gabrielle Price, George Danias, Ksenia Gorbenko, Joel Cantor, Pamela Valera, Aakash K. Shah, Matthew J. Akiyama Life.2023; 13(4): 1033. CrossRef
Minimal monitoring is a safe but underutilised strategy for hepatitis C virus treatment in Singapore Wei Xuan Tay, Samantha Jingyun Koh, Francis Kok Ban Teh, Yu Bin Tan, Tian Yu Qiu, Linn War Mai, Vivien Li Xin Wong, Jessica Tan, Andrew Kwek, Kwong Ming Fock, Tiing Leong Ang, Rahul Kumar, Yu Jun Wong Annals of the Academy of Medicine, Singapore.2023; 52(6): 321. CrossRef
HCV Microelimination for High-risk Special Populations Chung-Feng Huang, Guan-Jhou Chen, Chien-Ching Hung, Ming-Lung Yu The Journal of Infectious Diseases.2023; 228(Supplement): S168. CrossRef
Efficacy and safety of sofosbuvir/velpatasvir with or without ribavirin in hepatitis C genotype 3 compensated cirrhosis: A meta-analysis Jing Hong Loo, Wen Xin Flora Xu, Jun Teck Low, Wei Xuan Tay, Le Shaun Ang, Yew Chong Tam, Prem Harichander Thurairajah, Rahul Kumar, Yu Jun Wong World Journal of Hepatology.2022; 14(6): 1248. CrossRef
HCV Infection and Liver Cirrhosis Are Associated with a Less-Favorable Serum Cholesteryl Ester Profile Which Improves through the Successful Treatment of HCV Kilian Weigand, Georg Peschel, Jonathan Grimm, Martina Müller, Marcus Höring, Sabrina Krautbauer, Gerhard Liebisch, Christa Buechler Biomedicines.2022; 10(12): 3152. CrossRef
Brief Report: HCV Universal Test-and-Treat With Direct Acting Antivirals for Prisoners With or Without HIV: A Prison Health Care Workers–Led Model for HCV Microelimination in Thailand Ruamthip Supanan, Win Min Han, Weerakit Harnpariphan, Thornthun Ueaphongsukkit, Sasiwimol Ubolyam, Jiratchaya Sophonphan, Pisit Tangkijvanich, Sombat Thanprasertsuk, Anchalee Avihingsanon JAIDS Journal of Acquired Immune Deficiency Syndromes.2021; 88(5): 465. CrossRef
Background/Aims Non-alcoholic liver disease and alcoholic liver disease begin as simple steatosis that may progress to steatohepatitis and ensuing liver-related complications such as cirrhosis and hepatocellular carcinoma (HCC). We explored differences in characteristics between non-alcoholic steatohepatitis (NASH) and alcoholic steatohepatitis-related (ASH) HCC.
Methods NASH and ASH patients were identified from our department’s prospective HCC database. A total of 54 and 45 patients met predefined inclusion and exclusion criteria for the NASH-HCC and ASH-HCC groups, respectively. Clinical, biochemical and tumor characteristics were studied.
Results NASH-HCC patients were older compared to ASH-HCC patients (72±9 vs. 66±9 years, P<0.001) and less male predominant (65% vs. 98%, P<0.001). Prevalence of diabetes mellitus (78% vs. 36%, P<0.001) and hypertension (80% vs. 58%, P<0.001) were significantly higher in the NASH-HCC group. Liver function tests and Child-Pugh scores were similar. There were no differences in alpha-fetoprotein level, lesions found at diagnosis (unifocal/multifocal) or prevalence of portal vein invasion. In both groups, almost half of the patients were in TNM stage 4 at the time of diagnosis and more than 50% of patients were not suitable for any therapy. Median survival in the NASH-HCC and ASH-HCC groups were 13 and 7 months respectively (P=0.113).
Conclusions Despite significant differences in demography of the NASH-HCC and ASH-HCC groups, liver and tumor characteristics were comparable. Most patients were diagnosed late and were not amenable to curative or locoregional therapies. Better characterization of patients with NASH and ASH at risk of HCC is necessary to optimize screening, surveillance, and management strategies.
Citations
Citations to this article as recorded by
Non-receptor Type PTPases and their Role in Controlling Pathways Related to Diabetes and Liver Cancer Signalling Nidhee Chaudhary, Bellam Kiranmayee Current Pharmaceutical Biotechnology.2025; 26(5): 654. CrossRef
Diagnosis of Hepatocellular Carcinoma Using Gadoxetic Acid‐Enhanced MRI Based on LI‐RADS Version 2018 and LI‐RADS Modifications Yanjin Qin, Jing Zhang, Danyang Xu, Xiaoqi Zhou, Zhoukun Ling, Lujie Li, Qiaochu Zhao, Zhi Dong, Jifei Wang, Hua‐Song Cai, Hongxiang Li, Lie‐Guang Zhang, Shi‐Ting Feng Liver International.2025;[Epub] CrossRef
Advancements in Immunotherapeutic Treatments for Hepatocellular Carcinoma: Potential of Combination Therapies Yusra Zarlashat, Hassan Mushtaq, Linh Pham, Wasim Abbas, Keisaku Sato International Journal of Molecular Sciences.2024; 25(13): 6830. CrossRef
Association of modifiable metabolic risk factors and lifestyle with all-cause mortality in patients with hepatocellular carcinoma Hwi Young Kim, Hye Ah Lee, Pompilia Radu, Jean-François Dufour Scientific Reports.2024;[Epub] CrossRef
Global prevalence of metabolic dysfunction-associated fatty liver disease-related hepatocellular carcinoma: A systematic review and meta-analysis Harry Crane, Guy D. Eslick, Cameron Gofton, Anjiya Shaikh, George Cholankeril, Mark Cheah, Jian-Hong Zhong, Gianluca Svegliati-Baroni, Alessandro Vitale, Beom Kyung Kim, Sang Hoon Ahn, Mi Na Kim, Simone I Strasser, Jacob George Clinical and Molecular Hepatology.2024; 30(3): 436. CrossRef
Global Prevalence, Clinical Characteristics, Surveillance, Treatment Allocation, and Outcomes of Alcohol-Associated Hepatocellular Carcinoma Rebecca Wenling Zeng, Christen En Ya Ong, Elden Yen Hng Ong, Charlotte Hui Chung, Wen Hui Lim, Jieling Xiao, Pojsakorn Danpanichkul, Jia Hao Law, Nicholas Syn, Douglas Chee, Alfred Wei Chieh Kow, Sung Won Lee, Hirokazu Takahashi, Takumi Kawaguchi, Nobuhar Clinical Gastroenterology and Hepatology.2024; 22(12): 2394. CrossRef
Amitriptyline inhibits NLRP3 inflammasome activation via the ASM/CE pathway in a cell model of NAFLD QIN LIU, CHUNYAN NIU, QIANG ZHANG, SHIQIN SUN, YUE CHEN, YONGQIANG SHI BIOCELL.2024; 48(5): 759. CrossRef
The emerging age-pattern changes of patients with hepatocellular carcinoma in Korea Yuri Cho, Bo Hyun Kim, Joong-Won Park Clinical and Molecular Hepatology.2023; 29(1): 99. CrossRef
Correspondence on Letter regarding “Auranofin attenuates hepatic steatosis and fibrosis in nonalcoholic fatty liver disease via NRF2 and NF-κB signaling pathways” Seung Min Lee, Dae Won Jun Clinical and Molecular Hepatology.2023; 29(1): 171. CrossRef
An Overview of Hepatocellular Carcinoma Surveillance Focusing on Non-Cirrhotic NAFLD Patients: A Challenge for Physicians Annalisa Cespiati, Felice Cinque, Marica Meroni, Rosa Lombardi, Paola Dongiovanni, Anna Ludovica Fracanzani Biomedicines.2023; 11(2): 586. CrossRef
Factors associated with unrecognized cirrhosis in patients with hepatocellular carcinoma Yi-Te Lee, Mohammad A. Karim, Hye Chung Kum, Sulki Park, Nicole E. Rich, Mazen Noureddin, Amit G. Singal, Ju Dong Yang Clinical and Molecular Hepatology.2023; 29(2): 453. CrossRef
Exploration of the potential mechanism of the Fuzheng Xiegan decoction for treating hepatocellular carcinoma based on experimental and network pharmacological analyses Menghan Wang, Ni Zheng, Zhongchao Mai, Borong Zhou, Xinlin Yang, Miao Zhang, Wei Xia, Ying Ye European Journal of Integrative Medicine.2023; 60: 102257. CrossRef
Association Between Nutrient Patterns and Fatty Liver Index: Baseline Survey of the Japan Multi-Institutional Collaborative Cohort Study in Tokushima, Japan Nguyen Van Tien, Kokichi Arisawa, Hirokazu Uemura, Nahomi Imaeda, Chiho Goto, Sakurako Katsuura-Kamano Journal of Epidemiology.2022; 32(8): 376. CrossRef
Multimarker Panels for Detection of Early Stage Hepatocellular Carcinoma: A Prospective, Multicenter, Case‐Control Study Teerha Piratvisuth, Tawesak Tanwandee, Satawat Thongsawat, Wattana Sukeepaisarnjaroen, Juan Ignacio Esteban, Marta Bes, Bruno Köhler, Ying He, Magdalena Swiatek‐de Lange, David Morgenstern, Henry Lik‐Yuen Chan Hepatology Communications.2022; 6(4): 679. CrossRef
The Burden of Nonalcoholic Steatohepatitis: A Systematic Review of Epidemiology Studies Elliot B. Tapper, Charlotte Fleming, Adriana Rendon, João Fernandes, Pierre Johansen, Margarida Augusto, Sunita Nair Gastro Hep Advances.2022; 1(6): 1049. CrossRef
Herbal Medicine-derived Compounds for the Prevention and Treatment of Hepatocellular Carcinoma Zahra Farzaneh, Maryam Farzaneh Current Cancer Therapy Reviews.2022; 18(4): 230. CrossRef
Prognosis after Hepatic Resection of Patients with Hepatocellular Carcinoma Related to NAFLD or MAFLD: A Systematic Review and Meta-Analysis Zhujian Deng, Jiayong Su, Yuxian Teng, Si Xie, Rongrui Huo, Chaojing Chen, Liang Ma, Jianhong Zhong SSRN Electronic Journal.2022;[Epub] CrossRef
Intricate interpretation of etiology-specific outcome comparison in patients with hepatocellular carcinoma Hwi Young Kim, Jean-François Dufour Clinical and Molecular Hepatology.2020; 26(2): 238. CrossRef
Should you advocate for hepatocellular carcinoma surveillance in patients with alcohol-related liver disease or non-alcoholic fatty liver disease? Ju Hyun Shim Clinical and Molecular Hepatology.2020; 26(2): 183. CrossRef
From intestinal dysbiosis to alcohol-associated liver disease Beatriz Garcia Mendes, Bernd Schnabl Clinical and Molecular Hepatology.2020; 26(4): 595. CrossRef
Serum Myostatin Predicts the Risk of Hepatocellular Carcinoma in Patients with Alcoholic Cirrhosis: A Multicenter Study Ji Hyun Kim, Seong Hee Kang, Minjong Lee, Gi Soo Youn, Tae Suk Kim, Baek Gyu Jun, Moon Young Kim, Young Don Kim, Gab Jin Cheon, Dong Joon Kim, Soon Koo Baik, Dae Hee Choi, Ki Tae Suk Cancers.2020; 12(11): 3347. CrossRef
HCV Antiviral Drugs Have the Potential to Adversely Perturb the Fetal-Maternal Communication Axis through Inhibition of CYP3A7 DHEA-S Oxidation Hannah M. Work, John C. Hackett, Jed N. Lampe Drug Metabolism and Disposition.2024; 52(6): 516. CrossRef
Hepatitis C Virus: History and Current Knowledge Skender Topi, Elona Gaxhja, Ioannis Alexandros Charitos, Marica Colella, Luigi Santacroce Gastroenterology Insights.2024; 15(3): 676. CrossRef
Antivirals virtual screening to SARS-CoV-2 non-structural proteins Vinicius S. Nunes, Diego F. S. Paschoal, Luiz Antônio S. Costa, Hélio F. Dos Santos Journal of Biomolecular Structure and Dynamics.2022; 40(19): 8989. CrossRef
Arginine vasopressin and pathophysiology of COVID-19: An innovative perspective Hayder M. Al-kuraishy, Ali I. Al-Gareeb, Safaa Qusti, Eida M. Alshammari, Francis O. Atanu, Gaber El-Saber Batiha Biomedicine & Pharmacotherapy.2021; 143: 112193. CrossRef
Yu Jun Wong, Si Yuan Chew, John Chen Hsiang, Prem Harichander Thurairajah, Rahul Kumar, Eng Kiong Teo, Roshni Sadashiv Gokhale, Imran Bin Mohamed Noor, Jessica Tan
Clin Mol Hepatol 2019;25(2):218-222. Published online September 6, 2018
First
Prev
