Connection between Hepatitis C and Military Veterans
Vietnam War veterans who contracted hepatitis C during their service face significant long-term health risks, particularly if the infection remained untreated for decades. According to recent studies, about 20–30% of individuals with chronic hepatitis C develop progressive liver fibrosis leading to cirrhosis over time [3]. This condition greatly increases the risk of liver failure and liver cancer [1].
One of the most concerning long-term effects is the development of hepatocellular carcinoma (HCC), a type of liver cancer. Once cirrhosis is established, there is an annual 1–4% risk of developing HCC [1]. HCC risk remains significant even after successful treatment of hepatitis C with direct-acting antivirals (DAA), especially in those with advanced fibrosis or cirrhosis before treatment [1].
In addition to liver-related complications, hepatitis C can cause other systemic health issues such as cryoglobulinemia (an immune complex disease), kidney disease, diabetes, and certain lymphomas [1]. These extrahepatic problems contribute to overall morbidity among infected veterans. Some veterans may also experience chronic symptoms like fatigue and reduced mental stamina due to hepatitis C’s systemic effects [1].
Hepatitis C is also associated with nerve damage, causing peripheral neuropathy symptoms, which can seriously impact day-to-day functioning [5].
Veterans exposed to hepatitis C during the Vietnam War may have faced additional exacerbating factors such as exposure to Agent Orange and other toxins, although these are more linked to specific cancers and other diseases rather than hepatitis C itself [2][4].
Given these risks, veterans with chronic hepatitis C generally require ongoing liver disease surveillance, including regular HCC screening every 6 months in those with cirrhosis or advanced fibrosis, even after viral cure [1]. They also need management of extrahepatic conditions possibly related to hepatitis C and early antiviral treatment with DAAs to reduce long-term complications and systemic effects [1].
Financial support for testing and treatment of hepatitis C may be available for eligible veterans. The Department of Veteran Affairs has cured over 100,000 veterans with chronic hepatitis C since 2014, using drugs called direct acting antivirals (DAAs) [2]. Studies show that a combination of second-generation DAA regimes, such as sofosbuvir and simeprevir, produces fewer adverse effects and higher cure rates [6].
Approximately 3 million people in the United States have chronic hepatitis C, and the rate of infection is 1.8% in the general U.S. population, but increases to 5.4% in veterans enrolled for care from the VA [7]. Retired veterans have a higher risk of hepatitis C, possibly due to having a higher number of traditional risk factors associated with hepatitis C infections.
Experts advise regular testing for people who currently inject drugs and those who receive maintenance hemodialysis. Other risk factors for hepatitis C infection include having an HIV infection, certain conditions, receiving transfusions or an organ transplant before July 1992, and having an occupation in healthcare or public safety that involves the risk of a needle-stick injury or other exposure to the blood of someone with hepatitis C [8].
A severe enough presentation of hepatitis C in a veteran may entitle them to receive disability benefits from the VA. If a person does not receive treatment for hepatitis C, the infection can lead to liver cancer and other serious health issues.
As of 2019, approximately 25,000 veterans in VA care still require testing for hepatitis C [9]. Research from 2018 reports that veterans most likely affected by hepatitis C are people who served during the Vietnam war era, have alcohol or substance use disorders, have psychiatric conditions, and experience homelessness [10].
The highest prevalence of hepatitis C infection was in service members who served in Vietnam between 1964-1975, due to battlefield exposures with HCV-infected blood, sharing of HCV-infected personal items, and the use of unscreened blood products [11]. The active-duty military has a lower risk of developing hepatitis C infection compared to retired veterans [11].
Curing hepatitis C can prevent it from progressing to advanced liver disease, potentially cutting the death rate by up to 50% [12]. The Department of Veteran Affairs reports a higher prevalence of hepatitis C infections in veterans, particularly those who served in the Vietnam war era [11]. Eligibility for VA healthcare benefits may help veterans pay for care, treatment, and certain services related to hepatitis C.
References:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357138/
- https://www.hepatitisc.uw.edu/patients/hepatitis-c/treatment/va-treatment
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891841/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874448/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828487/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828487/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357138/
- https://www.cdc.gov/hepatitis/hcv/riskfactors.htm
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357138/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6138253/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357138/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357138/
- Despite being veteran soldiers who have undergone piercings and tattoos, they might still face significant long-term health risks due to chronic hepatitis C, particularly if the infection remains untreated for decades.
- Chronic hepatitis C can lead to various medical-conditions like liver fibrosis, cirrhosis, liver failure, liver cancer, cryoglobulinemia, kidney disease, diabetes, lymphomas, nerve damage, peripheral neuropathy, mental-health issues like fatigue and reduced mental stamina, and other chronic diseases.
- The Department of Veteran Affairs offers financial support for testing, treatment, and management of hepatitis C, which includes direct-acting antivirals (DAAs), and provides healthcare benefits for veterans to help pay for care, treatment, and services related to hepatitis C.
- The surveillance of liver disease and HCC screening, along with addressing mental-health concerns and adhering to a health-and-wellness lifestyle that incorporates fitness-and-exercise and nutrition, are crucial for veterans dealing with chronic hepatitis C to reduce long-term complications and systemic effects.
