What is Hepatitis C?
Hepatitis C virus is a condition marked by inflammation of the liver and sometimes leads to serious liver damage. The hepatitis C virus spreads through contact with infected blood or contaminated IV needles, razors, tattoo equipment, or other similar items. The early symptoms of this condition are often very mild, including: vague abdominal discomfort, fatigue, and joint pains. People can carry the virus for years without knowing. Over time, the virus can cause more serious health problems such as cirrhosis (i.e. scarring of the liver) and liver cancer. VA officials report an unusually high rate of hepatitis C in United States soldiers and veterans.
Veterans Are at a High Risk for Hepatitis C
It is estimated that over 230,000 veterans are infected with hepatitis C, and approximately 50,000 more are thought to carry the infection without knowing it. In 2000, VA Program Director for Infectious Diseases, Gary Roselle, stated “1 in 10 U.S. veterans are infected with hepatitis C virus, a rate that is five times greater than the 1.8 percent infection rate of the general population”. Additionally, statistics show that people born between 1945 and 1962 make up the largest group affected by hepatitis C. These individuals are more likely to contract the virus than any other generation. Coincidentally, this generation consists of many veterans who served in heavy combat wars, such as the Vietnam War. Research shows that this high incidence rate amongst veterans likely has to do with the following risk factors:
- Exposure to blood during combat
- Receiving blood transfusions before blood products were screened for hepatitis C
- Unsafe immunization techniques (e.g. jet/air gun injections, dirty needles and syringes)
- Large battle wounds
Over the years, a greater number of veterans began applying for service-connected compensation for hepatitis C.
How VA Rates Hepatitis C
VA includes hepatitis C in its disability ratings schedule, listing it under 38 CFR § 4.114, Schedule of Ratings – Digestive System, Diagnostic Code 7354. The rating criteria for this condition are as follows:
- “100% – near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain)
- 60% – daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly
- 40% – daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period
- 20% – daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period
- 10% – intermittent fatigue, malaise, and anorexia, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period
- 0% – nonsymptomatic”
VA Treatment and Research
Due to veterans’ increased risk of hepatitis C, VA has made it a priority to perform screenings on as many veterans as possible. VA is the single largest hepatitis C virus care provider in the United States. Specifically, as of 2016, VA has treated more than 76,000 veterans infected with the virus and approximately 60,000 have been cured. In fiscal year 2015, VA allocated $696 million for new hepatitis C drugs. This spending amount made up 17 percent of VA’s total pharmacy budget for the year. Those who are treated for hepatitis C within the VA healthcare system are then entered into VA’s National Hepatitis C Clinical Case Registry, designed to provide population-based data. As of mid-2018, VA has announced that all veterans in VA care who have the virus are eligible for treatment.
Currently, there are two main drugs that have proven to be most effective in the treatment of the hepatitis C virus: Sovaldi and Harvoni. However, these drugs are very expensive. High-risk groups, comprised of individuals who are at high risk of complications and need immediate care to prevent the virus from causing further liver damage, are identified as benefitting the most from these drugs.
Furthermore, veterans with hepatitis C virus and liver cirrhosis are significantly less likely to die or to progress to a stage in the disease called decompensated cirrhosis (i.e. a stage of liver disease in which the patients are at a significant risk of dying unless they receive a liver transplant) if they use statins (i.e. a type of medication) to control blood cholesterol. Specifically, a 2016 study demonstrated that hepatitis C patients using statins were associated with more than a 40 percent reduction in the risk of death or decompensated cirrhosis. Statin users were also less likely to progress to having cirrhosis at all.
VA’s new and ongoing research includes clinical trials of treatments, epidemiologic studies, investigations of the biological mechanisms of infection, and studies on identifying and removing barriers to treatment. Additionally, VA is working on projects to improve the screening and testing methods for hepatitis C, and developing models of care to optimize treatment and clinical standards at all stages of hepatitis C infection.