VA leads the medical world in screening and treatment BY DR. STEPHAN D. FIHN
Some 200 million people worldwide are infected with the hepatitis C virus, nearly 5 million in the United States alone. Each year, about 230,000 new hepatitis C infections are recorded. VA recognizes this major public health problem and has established special programs to address the needs of veterans with, or at risk for, hepatitis C.
Hepatitis is the inflammation of the liver, usually from a viral infection but sometimes from toxic agents. Five known viruses cause inflammation of the liver, resulting in hepatitis A, E, C, D or E. Hepatitis C is the single most significant cause of liver disease and liver transplants, spreading through contact with infected blood and other body fluids.
Viral hepatitis symptoms are similar, no matter the type. Some people infected with hepatitis C show no symptoms but can infect others without knowing it. Symptoms can take up to 20 to 30 years to appear. They include jaundice, fever, loss of appetite, fatigue, dark urine, joint pain, abdominal pain, diarrhea and nausea.
Rarely will viral hepatitis alone cause liver failure and death. Rather, those with chronic hepatitis C infection are more susceptible to liver failure, or cirrhosis, and liver cancer. Increases in the rate of liver cancer over the past two or three decades may well be due to hepatitis C virus acquired during the 1960s and 1970s.
The risk of hepatitis C, as with some other blood-borne diseases, can be lowered through lifestyle precautions. Other risk factors are beyond a person's control. Most at risk are people who:
are hemodialysis patients;
have ever injected drugs;
have jobs that expose them to human blood;
received a blood transfusion before July 1992;
received clotting factors made before 1987;
have had sexual contact with an infected person;
or have had multiple sex partners.
Several blood tests can determine if you have been infected with hepatitis C. Your doctor may order just one or a combination of these tests. Two drugs currently approved for treatment are interferon and ribavirin, which can be taken alone or in combination. No vaccinations are currently available.
Although VA already screens, tests and treats more people with hepatitis C than any other health system in the world, we continue to explore new ways to improve
care. VA centers are dedicated to researching hepatitis C in several states. VA also sponsors educational conferences, symposiums and teleconferences for healthcare workers and patients. Also, a VA Web site has been developed to share the latest hepatitis C information: Hepatitis.va.gov.
In 1998, VA opened a national registry to identify patients with hepatitis C and track their clinical status, with the goal of improving care.
A recent study of nearly 1,300 patients at 20 VA medical centers found a hepatitis C infection rate of 5.4 percent. The figure for Vietnam War veterans was more than double that.
Another study found that up to 70 percent of new hepatitis-C patients are unable to begin antiviral therapy due to alcohol or substance abuse, or depression. VA scientists in Portland are exploring ways to reduce the mood disorders often resulting from interferon treatment.
VA medical centers nationwide conduct a number of clinical trials of hepatitis C treatments. Participating veterans benefit from free checkups by hepatitis C specialists and free medications. They also may qualify to receive experimental medications that are not yet on the market. The decision to participate in a clinical trial should be considered carefully. Ask your doctor about what trials may be appropriate for you. It may also help to talk with friends and family about your decision.
Dr. Stephan D. Fihn is acting chief research and development officer for the Veterans Health Administration.
Living Well is designed to provide general information. It is not intended to be, nor is it, medical advice. Readers should consult their personal physicians when they have health problems.
