Experts Urge Screening of Veterans for Hepatitis C
Nov. 11, 1999 (Dallas) -- Experts at the 50th Annual Meeting of American
Association for Liver Disease reported that more and more veterans --
particularly Vietnam-era veterans -- will die as a result of infection with
Currently about 3.5 million veterans receive their medical care at Veterans
Affairs (VA) Medical Centers. Megan Briggs, MPH, says a screening study of
veterans treated at an outpatient clinic at the San Francisco VA Medical Center
suggests that as many as 18% of veterans are infected with hepatitis C, a virus
that lingers undetected for decades but may suddenly flare up. When the virus
becomes active it attacks the liver, causing scarring and eventually cirrhosis.
Patients with cirrhosis due to hepatitis C are also at an increased risk of
developing liver cancer. Cirrhosis and liver cancer often lead to the need for
a liver transplant.
In recent years, the VA has become aware of a growing number of hepatitis C
cases among both its outpatient population and hospitalized veterans, says
Theresa L. Wright, MD, chief of gastroenterology at the VA Medical Center in
San Francisco. Wright and Briggs co-authored a study based on screening of
veterans receiving outpatient care.
Wright says that among the risk factors associated with hepatitis C
infection, "IV drug abuse just overwhelmed all other factors." That's
significant because the highest prevalence was found among "patients in
their late 40's and early 50's -- the veterans of the Vietnam era." She
says that, "it isn't simply a matter of having served in Vietnam but rather
a timing thing: Vietnam coincided with the explosion of IV drug abuse in the
U.S." Thus, it is the timing of service that links these veterans to the
The link between Vietnam-era veterans and hepatitis C is compelling,
according to a fact sheet from Samuel B. Ho, MD, assistant professor of
medicine at the VA Medical Center, and University of Minnesota, Minneapolis.
The sheet cites a VA tracking study that analyzed 95,000 hepatitis C tests from
173 VA centers and 600 VA associated clinics. That study found that Vietnam-era
veterans account for about 64% of positive hepatitis C tests, he tells
Ho says that the Vietnam-era veteran who receives treatment at the VA
carries a laundry list of risk factors for hepatitis C. "Veterans of this
age who get their medical care at the VA either have service-connected injuries
or are here because they have chronic problems such as drug and alcohol abuse
or psychiatric diagnoses that prevent them from working, and thus they qualify
for care." Ho says any service-connected injury may have "exposed the
person to contaminated blood," and addictions "are strongly associated
with IV drug use."
Another risk factor identified by Briggs and Wright is "needle-stick
during combat medical service," says Briggs. She says needle-stick and
other medical treatment blood exposure may have been more common during Vietnam
"because they operated in situations where they were just surrounded by
blood." Wright says that if this risk factor can be confirmed in larger
studies, "it may become a question of liability for the VA. If the
hepatitis C is a result of needle-stick while serving as part of a medical
unit, I think there may be some liability for treatment."