Experts Urge Screening of Veterans for Hepatitis C
WebMD News Archive
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
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."