Experts Urge Screening of Veterans for Hepatitis C
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."
Questions such as that have led the VA to consider a national study to determine the true incidence of hepatitis C in the VA population. "That's why we are conducting this study in San Francisco, and we will do another pilot in Seattle," says Wright. She says the VA will use those pilots to design a national study.
While awaiting a national prevalence study, Ho has developed a screening and treatment model for use in regional VA centers in Minnesota. He has initiated hepatitis C screening as part of standard outpatient care and has developed education and treatment guidelines for veterans who test positive.
But even though the VA has approved use of the latest therapy for hepatitis C -- a combination of two powerful drugs, interferon and ribavirin -- many of the patients treated at the VA are not good candidates for treatment. The treatment, says Ho, is usually not recommended for patients who have alcohol or drug abuse problems or who have a diagnosis of a psychiatric illness. One of the side effects of interferon treatment is depression, he says.
Wright agrees that the outpatients treated by the VA are not the best candidates for therapy, but "we know that we get a 40-50% response with combination therapy. I think that somewhere in that 350,000 that we think are hepatitis C positive there must be enough people who will achieve that response that it makes it worthwhile to find them."