Congress has mandated that Veterans be treated for Hepatitis C in all VA clinics and hospitals throughout the United States. This means that if you are a vet and have HCV the VA nearest you MUST treat you. If you are being refused treatment, contact your Congressman immediately and give him the name of the VA clinic and the name of the person who has refused to treat you. There are treatment criteria that need to be followed for treatment, however.

Veteran Infection Rates:

• 20% of the National infection rate (1.8%) are veterans
• 62.7% are Vietnam War Era Veterans
• 4.2% are WWII Veterans
• 5% are Korean War Veterans

• IV Drug use    = 54%
• Transfusions   = 24%
• Tattoos           = 45%

Veteran Infection by Race:

• African American    = 29.4%
• White                       = 46%
• Asian                        =  4.9%

Screening Criteria for Testing in a VA clinic:

• Vietnam Era Veteran
• Requested by patient
• Blood products received prior to 1992
• IV/Intranasal drug use
• Blood exposure
• Multiple sex partners
• hemodialysis
• tattooing/body piercing
• elevated liver function tests
• intemperate alcohol use

Contraindications to Therapy:

• Non-compliance - i.e. not showing up for clinic, missing appointments, not following doctors orders.
• Life limiting non-hepatic disease
• Moderate to severe psychological disease
• Inadequite social support
• Homeless - due to no ability to keep meds cold.
• Failure to use birth control - while on combo treatment
• Pregnancy
• Drug and/or alcohol use - Must be clean and sober 6 months prior to start of treatment
• Decompensated liver disease
• Autoimmune disorders

The VA requires a genotype test done, in order to better assess the duration and type of treatment given. The VA also screens the alpha-fetoprotein every 6 months, due to the fact that many people have a normal AFP but have been diagnosed with HCC.

The jet injector issue has not been looked at by the VA because they assume there is another form of transmission, such as drug use, tattoos, piercing, etc.

Every VA clinic should be offering the Rebetron (combo) treatment to all vets who meet the criteria for treatment. VA clinics should also be offering and using IntronA, Infergen, and Roferon for those who cannot take the ribavirin in the Rebetron combo. Monotherapy with any of these is not advised in other cases.

The VA is now doing studies on Pegalated Interferon + Ribavirin.

Current Recommendations:

• Prescribe Rebetron (3 times a week plus 1000 to 1200 mg ribavirin). Test PCR for viral load at 24 week point. If positive, discontinue treatment. If undetected for virus at 24 weeks, continue treatment for another 24 weeks, depending on genotype of patient.
• All genotype 1 patients should be screened at 24 weeks for viral load and discontinued if viral load is present. All other genotypes should be treated for 24 weeks. Genotype 1 should be treated for 48 weeks if possible.
• Monotherapy patients who cannot take ribavirin should be screened for viral load at 3 months. If undetected, treatment should continue to the 48 week point. If positive at 3 months for viral load, stop treatment.
• Patients who relapse after monotherapy should be given Rebetron (combo) for 24 weeks and screened for viral load.
• Patients on methedone should be treated if they have a good support system and follow all clinic requirements.

Information Provided by:

Digestive Disease Week 2000, San Diego, CA, May 23, 2000
Seminar given by:  Dr. Lennox Jeffers, MD, Florida VHA