Vets Fighting a Postwar Enemy

To many veterans, the cascade of scourges has a biblical quality: Post-traumatic stress disorder. Agent Orange. Birth defects. Gulf War syndrome.

Now there is hepatitis C. The chronic liver ailment turns up in ex-service personnel who use VA facilities--especially Vietnam-era vets--at a rate four times the national average, medical experts say.

While the prevalence of the disease among veterans is little known outside that community, it was clearly on the minds of former military personnel at this year’s Vietnam Veterans of America Convention, which concludes today in Anaheim. Booths offering the latest therapies and testing devices for hepatitis C were most common, apart from those selling memorabilia, among displays set up at the Anaheim Marriott.

One company gave out more than 200 free home hepatitis C test kits on the first day of the convention. A steady stream of veterans visited the booth to learn about the test, which retails for $70.

Hepatitis C is a progressive disease that can go undetected for as long as 30 years and lead to liver cancer, cirrhosis and liver failure. In the last year, the disease has drawn increasing attention from veterans and the hospitals that treat them.

The Veterans Health Administration last year decided to screen every veteran who comes to its medical facilities for the disease and this year committed to costly antiviral therapy for all veterans who have the illness and would benefit from these state-of-the-art drugs.

“It is a very high-profile commitment from Washington,” said Dr. Teresa Wright, a nationally recognized expert on hepatitis C who is chief of gastroenterology at the San Francisco VA Medical Center.

Especially at risk are former combat soldiers who were exposed to battlefield wounded and those who received transfusions before 1992, when testing made it possible to identify the hepatitis C virus. Even by sharing razors or etching crude tattoos in foxholes, soldiers may have increased their likelihood of getting or transmitting the virus.

Michael Weber, a 101st Airborne Division vet from Miami, believes he contracted hepatitis C in Vietnam. The 48-year-old vet learned he has the virus in 1993 during a visit to the VA hospital for Agent Orange screening. Hospitalized four times in the last year for hepatitis-related problems, the ponytailed veteran went into liver failure and a four-day coma and almost died earlier this year.

Weber, whose skin is tinged yellow from jaundice, has been treated for other problems as well. Like many Vietnam-era vets, he feels numbed by a never-ending parade of ailments.

“I will not live out a normal life span,” he said. “I get tired of being diagnosed for something else. Every time I get over one thing, it is another.”

Weber represents one paradox in hepatitis C antiviral therapy. His clinical depression--which often is associated with chronic illness--makes him ineligible for the interferon-plus-ribavirin treatment because it could seriously worsen his depression, even lead to suicide.

Rather than dwell on the frustration of that, he goes on with his life, saying frankly he expects to die of hepatitis C complications sometime soon. In the meantime, he follows a strict diet, avoids alcohol and stress, and hopes for a transplant.

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Hepatitis, an inflammation of the liver, was identified in the 1940s. It is commonly caused by a virus. Scientists had developed tests for hepatitis A and B viruses by the early 1970s, and there is a vaccine for both.

Type C, however, remained a mystery, and researchers took almost 20 years to isolate the virus and create a test for it. As a result people still contracted hepatitis C through 1992 from blood transfusions, though the blood had been screened for other types of hepatitis.

VA experts estimate that a soldier receiving five units of blood during a transfusion in Vietnam had a 6% to 12% chance of getting hepatitis C.

There is no certain cure for hepatitis C. Even the new antiviral therapies, which take up to 48 weeks of treatment, appear to be successful so far in only about 40% of cases.

“This is a slow, progressive disease that does liver damage,” said Dr. Timothy Morgan, who heads the hepatitis C program at the Long Beach VA Medical Center. “It is important to identify those with the virus because if you drink alcohol, more than two drinks a day, . . . the disease will progress faster.”

The Centers for Disease Control in Atlanta estimates that 4 million Americans--about 1.8% of the population--have hepatitis C, though the vast majority are unaware of it.

Those at increased risk for the disease include intravenous drug users, people with multiple sex partners or tattoos, those on hemodialysis and those who share toothbrushes and razors. The illness occurs more frequently among lower socioeconomic groups, which includes the portion of veterans who utilize VA facilities, medical experts said.

The Veterans Health Administration offered a diagnostic test to everyone using a VA medical facility on March 17--about 26,000 vets. Based on these results, officials estimate that 8% to 10% of vets who use VA facilities nationally have the disease.

Nationwide, that means about 350,000 veterans have hepatitis C, said Dr. Toni Mitchell, who heads the hepatitis C program for the Veterans Health Administration. VA medical officials estimate that about 70,000 would qualify for the antiviral therapy, which costs about $18,000 for the full 48-week cycle.

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Others--many of them less seriously ill or whose health makes them unsuitable for antiviral therapy--would be treated with diet changes, educational programs and counseling, in an effort to slow the illness.

Counseling is particularly important because many veterans feel a sense of doom attached to a positive diagnosis.

“One of the most baffling things is how to teach your patients to learn how to truly live with hep C,” said Carol Craig, clinical research coordinator at the Long Beach VA Medical Center. “Emotional support is extremely important because patients have a life-threatening disease with an unpredictable path. They lose the potential to dream about their future.”

Dr. Mitchell said it is difficult to determine what it would cost to provide appropriate treatment to all veterans with hepatitis C and said Congress is considering raising the VA budget, which has been stagnant for several years, in part to accommodate costs for hepatitis C testing, education and treatment.

“It is a significant challenge for the VA to be able to address this,” she said. “But it shouldn’t be considered any different from any other disease whether it is diabetes, high blood pressure or having open heart bypass. This is part of medical care. It is what we do.”

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New Scourge

While hepatitis C occurs in 1.8% of Americans, the rates are far higher for veterans. A sampling of patients at VA hospitals nationwide in March found rates from 3 to 10 times higher.

Northern California: 6%

Southern California: 8.5%

San Francisco: 14%

New York City: 18%

Source: Veterans Health Administration