October 26, 2001

Veterans Warned to Get Tested for Hepatitis C

As Veterans Day approaches Nov. 11, we pay tribute to the men and women who have fought for our country. But the day can also act as a reminder to veterans that they are at greater risk for hepatitis C, the leading cause for liver transplantation in the United States.

"Veterans are at increased risk for contracting hepatitis C," said Adrian M. Di Bisceglie, M.D., chief of hepatology at Saint Louis University School of Medicine and medical director of the American Liver Foundation. "One in 10 U.S. veterans is infected with hepatitis C, a rate five times greater than the general population. Veterans, especially of the Vietnam era, have added risks related to exposure to infected blood on the battlefield or through blood transfusions received during combat casualty care."

Two years ago, in testimony before the U.S. House of Representatives, Dr. Di Bisceglie called for increased federal research and treatment programs. He stressed the need for additional resources to ensure that the Veterans Health Administration is prepared for the anticipated dramatic increase in HCV cases.

The effort was successful. "The federal government has allocated funds for the testing and treatment of veterans who have hepatitis C, but the first step is for the veterans to know that they have it," Dr. Di Bisceglie said. "And so we encourage them to go to their local VA health centers to ask for testing, and if they are positive, to discuss treatment with their physicians."

Hepatitis C is one of the most serious public health problems that the United States faces in the 21st century. The Centers for Disease Control and Prevention estimates that the current 10,000 annual deaths in this country that are attributed to HCV could triple within the next 10 years, and will soon kill more people each year than AIDS.

Raising awareness among veterans and others that may be at risk, to encourage getting tested for HCV should be a top priority, Dr. Di Bisceglie believes. An estimated 70 percent of the almost four million people in the United States with HCV who were infected---often exposed 10 to 30 years ago---are unaware of their condition. "It can take several decades for hepatitis C to do its dirty work," said Dr. Di Bisceglie. "It grows within the liver steadily but very slowly, and usually causes no symptoms until serious liver damage sets in."

Those that are at risk for HCV have:

• Used illegal injection drugs, even once, or used cocaine intranasally
• Had a blood transfusion or an organ transplant prior to 1992, when a reliable screening test for donated blood came into use
• Been injured by a needle (or other sharp object) with infected blood, such as those in the health care profession
• Had intimate contact with anyone with HCV

When a patient is diagnosed with HCV, reactions can run the gamut. "Someone who currently feels well may think it's nothing to be worried about, and another person may think it's a death sentence," said Dr. Di Bisceglie. "The truth is somewhere in between. Hepatitis C does not progress in everyone, and if it does, it progresses very slowly. It's not something to be panicked about, but to pay attention to."

And there is some good news. There is a new drug therapy that is effective for about 55 percent of the patients with HCV, and Dr. Di Bisceglie is chair of the largest and longest study of chronic HCV to date, to improve these cure rates. "It's very exciting to be involved in an area of medicine which has seen so many advances," Dr. Di Bisceglie said. "The virus was only discovered in 1989. We've gone from identifying the virus, to taking major steps towards a treatment that can apply to and help the majority of people with this disease."