June 30, 2000

VA Fights Hepatitis C — The Silent Stalker

by Oziel Garza
VA Office of Public Affairs

A silent killer is stalking veterans. It is the most common chronic blood-borne infection in the United States, responsible for about 10,000 deaths each year, a figure the Centers for Disease Control and Prevention (CDC) expects to triple during the next 10 to 20 years. But perhaps most alarming is the disease's prevalence among veterans. Estimates place it between 8-10 percent, far above the 1.8 percent infection rate in the general population.

The disease is hepatitis C and many veterans don't even know they're carrying this elusive virus. That's because the virus can remain dormant anywhere from 10 to 30 years. When symptoms do appear, they generally take the form of fatigue, loss of appetite or abdominal pains. By that time, the virus may have already caused serious liver damage that could lead to potentially fatal cirrhosis or even cancer of the liver. More than 50 percent of all patients receiving liver transplants in VA hospitals were found to have the hepatitis C virus.

With veterans at high risk, VA launched an all-out offensive. VA Acting Under Secretary for Health, Dr. Thomas Garthwaite, stepped forward to lead the assault. One of first steps was to established two Hepatitis C Centers of Excellence at the Miami and San Francisco VA Medical Centers. The centers coordinate treatment and research efforts, as well as develop educational materials for patients and their families, health-care providers and counselors who advise patients prior to and following testing.

The Miami Hepatitis C Center of Excellence has adopted a multifaceted approach to combating the rising hepatitis C epidemic, said Dr. Lennox J. Jeffers, chief of Hepatology at the Miami VA Medical Center and director of the Miami Center of Excellence. "We are telling veterans what hepatitis C is and what precautions they should take if diagnosed." He explained that those infected with the virus should avoid behaviors that can accelerate viral damage to the liver, such as excessive alcohol consumption, and avoid behaviors that can spread the virus to others, such as intravenous drug use.

Dr. Teresa L. Wright, chief of gastroenterology at the San Francisco VA Medical Center and director of the San Francisco Hepatitis C Center of Excellence, says her center is currently studying new drug treatments for hepatitis C. One is called VX 497, an inhibitor of one of the enzymes essential for synthesis of the hepatitis C ribonucleic acid (RNA). RNA is a group of nucleic acids essential for protein synthesis.

Advances made at the two centers are being disseminated through a series of national conferences. At the latest conference, held March 23-24, VA nurses, pharmacists, counselors and veterans service organization representatives were on hand to learn about the latest research. "What we hope is that people who come here (to the conferences) will go back to their medical centers and their networks and train others at the local level," said Dr. Toni Mitchell, chief consultant for VA Acute Care.

Additional conferences are planned. The next one is scheduled for August and will emphasize hepatitis C treatment guidelines. Addressing the epidemic, VA Deputy Under Secretary for Health Dr. Thomas L. Garthwaite, who plans to be at the August conference, said, "The good news is that we are finding our patients who have hepatitis C, we are testing them, we are treating them, and we have set forward an aggressive agenda to understand the disease better and search for new answers."

One of Mitchell's priorities is reaching at-risk veterans. "Outreach will always be our greatest challenge," she said. She explained that VA only treats about 10 percent of all veterans and it can be very difficult to reach the other 90 percent. So how will she reach them? To start, she partnered with the American Liver Foundation, Hepatitis Foundation International, veterans service organizations and other federal agencies such as the CDC.

Since taking on the epidemic, VA has established the centers of excellence, the educational conferences, the outreach partnerships, and a national registry, catapulting VA to the forefront of hepatitis C research, treatment and education. "VA has taken a very aggressive stand," noted Jeffers. "This (multifaceted approach) is unheralded in the treatment of hepatitis C."

Should you be tested for Hepatitis C?

* Have you ever used a needle to inject drugs like heroin or cocaine, even if it was many years ago?

* Did you have a blood transfusion or organ transplant before 1992?

* Did you receive blood products before 1987?

* If you were or are a health care worker, have you had contact with blood on the job?

* Were you on long-term kidney dialysis?

* Have you shared someone else¹s razor, toothbrush or other personal items that might have had blood on them?

* Did your mother have hepatitis C?

* Have you had sex with someone who has hepatitis C or have you had many sex partners?

* Are you a Vietnam-era veteran?

If you answered yes to any one of these questions, then you should get tested.

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