2/503d VIETNAM Newsletter - December 2009, Issue 9

2/503d VIETNAM Newsletter Contact: [email protected] December 2009 / Issue 9 For the men, and their families, of the 2d Battalion, 173d Airborne Brigade (Sep) ~ We Try Harder! A RACE AGAINST TIME Hepatitis C Diagnosis and Treatment (Excerpt) By Claudia Gary It seems so obvious—a no-brainer, really. If one disease is responsible for the majority of liver transplants in the United States, and if liver function tests generally do not reveal that disease, but a simple blood test for it has been available since 1992, then surely that test must be included in standard blood screening protocols. Right? Wrong. In most cases, the test for hepatitis C is given only if you request it by name. One Vietnam veteran heard about hep C and requested the test. But his HMO said the test wasn’t covered since he “wasn’t in a risk group.” Because all Vietnam-era veterans are at risk for hepatitis C, he persisted and got the test. He tested positive, which made him angry. If he had been diagnosed earlier, he could have made lifestyle changes to minimize the liver damage and received treatment for the virus at an earlier stage. Like many hepatitis C patients, this Vietnam veteran prefers anonymity due to the stigma associated with this disease. He believes he became infected while in service, either from a tattoo or an air gun injector. He doesn’t deal with the VA, but many veterans have reported that the VA presumed they were intravenous drug users unless they proved otherwise—guilty until proven innocent. In addition to battle-related infections, many veterans were infected with hepatitis C through blood transfusions prior to its identification in 1992. Some were infected through emergency transfusions of unscreened blood. There are also reports that the disease has been spread through medical procedures at VA facilities. The lack of testing, the long-term lack of information, and the difficulty in establishing a service-connected claim have added to the doubts, mistrust, and frustration that many veterans already feel toward the VA. But there is no time to waste; every veteran should be tested for hepatitis C. Although the Vietnam War ended nearly 35 years ago, this particular wound is now taking a serious toll among Vietnam-era veterans. Some who were infected during that war only recently learned of the damage to their livers. Many still do not know. Some Progress: There have been improvements. Medical treatments have become more effective and easier to tolerate, due to the 2001 introduction of pegylated (long-acting) interferon. Information, too, has become more accessible, as have support groups. In the last ten years, according to Vietnam-era veteran, patient activist, and registered nurse Ron Iams, “We’ve gone from a world where I had to convince doctors that there was a treatment for hepatitis C to a world where physicians in any VA clinic at least know what hep C is about and where to get the latest information.” At the same time, “We’re seeing an explosion of cases of liver cancer related to hepatitis C,” according to Dr. David Ross, who is the director of Clinical Public Health Programs for the Department of Veterans Affairs. “We have roughly 220,000 veterans who have been exposed to hep C,” he said. “Not all of those patients have chronic hep C, [but] those who do are at risk for cirrhosis and liver cancer.” Current treatment for hepatitis C includes use of pegylated interferon and ribavirin, which can be highly effective at clearing the virus but also can cause side- effects that make treatment very challenging for many patients. For this reason, support groups and plenty of information are essential. Dr. Doris Strader is co-author of the most recent guidelines for medical professionals —“Diagnosis, Management, and Treatment of Hepatitis C: Page 1 of 25