The VA Hepatits C Revolution

By Tyler Francke, Veterans News Magazine

Chris, a Vietnam-era Army veteran, lived with hepatitis C for years. Now, thanks to new and effective treatments provided by the federal VA health care system, he’s cured.

Chris enlisted in the early ’70s and was stationed at Fort Bliss, Texas. After discharge, he worked as a wood cutter for 23 years and is now an over-the-road truck driver. He doesn’t know when he contracted the virus (it can be carried for decades before symptoms manifest), but he got a positive diagnosis in 2004.

“I got real sick back then,” he recalled. “It wasn’t even the hep C. I had pneumonia. But what happened was, I went to the hospital, and the doctors said that my eyes were a bit yellow. I had some jaundice. They drew some blood; they did the test right there and said, yeah, I needed to go see somebody.”

Symptoms of hepatitis C, a virus that primarily affects the liver, include fever, fatigue, nausea, abdominal pain and yellowish pigmentation of the skin (also called jaundice). In more serious cases, it can cause liver disease or cirrhosis, which could eventually lead to cancer or liver failure.

Unfortunately, the interferon-based treatments available at the time were cumbersome, expensive and had a number of adverse side effects. Dr. Michael Chang, section chief for GI and hepatology at the Portland VA Medical Center, said that because of these side effects, the average dropout rates (30 percent) were higher than the cure rates (about 26 percent).

“The cure rates were abysmal,” he said. “It was something that a lot of patients didn’t really want to go through unless they had a lifethreatening case.”

Chris said that, back in 2004, he was interested in the treatment anyway, but his doctors advised against it.

“I guess the treatment was pretty harsh, and they didn’t think I would make it through very well,” he said. “I wanted to do it, but now I understand why they didn’t. My liver wasn’t at risk. I have no hard feelings about it.”

In 2011, the state of hepatitis care started to change for the better, according to Chang. New drugs and treatments began to be developed, ones that did not rely on interferon and had minimal side effects. Cure rates started to rise dramatically.

“Over the past few years, there’s been an explosion of options,” Chang said.

The new treatment regimens are orally based and typically last just eight to 12 weeks. And they are extremely effective, with cure rates of 94 percent or even higher, according to VA statistics.

The only remaining barrier was cost. But that changed in 2016 and 2017, when Congress appropriated a total of $3 billion to the VA for hepatitis C treatment. That has opened the door for any eligible veteran to receive the treatment if they wish.

“It’s a re-education process,” said registered nurse Dana Smothers, nursing care coordinator for the Portland VAMC’s hepatitis C program. When veterans call the confidential hep C hotline, Smothers is the voice on the other end of the call. “We hear people say all the time, ‘Oh, I don’t need the treatment. I’m not sick enough.’”

“We’re clarifying what are now misconceptions,” Chang agreed. “Anyone with hepatitis C now has access, and we are actively encouraging everyone to participate.”

The campaign has led Chang and Smothers to go public with some startling, but true, statistics. For example, the VA estimates that three out of four people living with hepatitis C don’t know that they have the virus, because they’ve never been tested and their symptoms have yet to surface.

Baby boomers are at higher risk for carrying the infection, and veterans are more than twice as likely to be hep C-positive as the general population. Why?

“The single biggest risk factor for hepatitis C is being stationed outside the United States,” Chang said. “That’s the main reason veterans are at higher risk, especially Vietnam veterans.”

A common misconception is that hepatitis C is a sexually transmitted disease. It is actually rare for the virus to be contracted this way because it requires direct blood-to-blood contact. However, it can be transmitted through intravenous drug use, nonsterile tattoos or body piercings and blood transfusions or organ transplants prior to 1992.

Smothers said the virus can be spread through combat injuries, vehicular accidents, even sharing razors.

A simple blood test can determine whether someone is infected, and the results are typically known within 24 hours. Because of the higher prevalence in veterans born between 1945 and 1965, the VA — along with the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force — is recommending that everyone in this generation be tested.

Portland VA Nursing Care Coordinator Dana Smothers, left, and Dr. Michael Change, discuss the results of a Fibroscan assessment at the Portland VA Medical Center. Fibroscan is a fast, accurate, painless, and non-invasive techbology that replaces the uncomfortable liver biopsy.

Official VA Portland Health Care System photo by Keilli Roesch

“They’re the need-to-know generation,” Smothers said, of baby boomers. "This is vital information for them."

Chris was contacted about the new VA program in 2016 and quickly got on board. He was prescribed a daily dose of Harvoni (generic name: sofosbuvir) and ribavirin. Thanks to the congressional funding, the treatment cost him just a few dollars — the same copay as a multivitamin.

The regimen consisted of the daily pills, as well as routine labs at his local clinic once a month.

“After three months, I went in to get tested one last time, and they said they couldn’t find the virus in me anymore. I was completely hep C-free,” he said. “That felt really good to hear.”

He said he encourages other veterans who may be living with hepatitis C to call the confidential hotline and get tested.

“I do recommend the treatment, especially to anyone who has been diagnosed,” he said. “I know, for me, I didn’t think it was a big deal. But when your immune system gets attacked, you wind up with other problems.”

For more information about the VA’s hepatitis C program, call 503-220-3471.