We have all read news stories about the difficulty veterans with active chronic HCV infection are having getting treated with Sovaldi at the VA. Some articles express a more reality-based report on the service-connected HCV outbreak among Vietnam veterans. Is there a shift in attitude away from the offensive myth of widespread IVDU in this much maligned veteran population?
Although we know that IVDU was rare in Vietnam from a 1973 government report, service persons who did engage in this behavior were a health menace to their comrades in combat and during any other events when their blood was transferred on and into another person’s body and blood stream.. (They were a menace to sex workers too.) During a typical tour of duty in Vietnam, exposure to IVDUers bodies, dead or alive, were in fact a service-connected HCV risk factor that should be added to the existing long long list of SC risk factors.
But the most devastating transmissions of hepatitis occurred during transfusions due to the huge viral loads in the blood bags. CBS (LINK):
“In 2013, Vietnam veteran Zion Yisrael (right, CBS image) was told he had five years to live. He has stage 4 liver disease, caused by hepatitis C — which has infected as many as 230,000 veterans. Most veterans contracted it in Vietnam where it was spread by battlefield blood transfusions and vaccinations.
So far they have treated about 35,000 veterans, that’s just 15 percent of the veterans infected with hepatitis C.”
Gilead’s gouging policy has resulted in even fewer Medicaid HCV patients getting treated–only 3%. According to the Senate Finance Committee press conference, “…in 2014, Medicaid programs spent $1 billion on Gilead’s Hepatitis C drugs, yet more than 97% of Medicaid patients went untreated.” Medicare costs were even higher.
The 144-page bipartisan report is a marketing case study. The pdf link is below.
SFC Sovaldi Report Executive Summary1 The Price of Sovaldi and Its Impact on the U.S. Health Care System (Full Report)
Recent VA research (Nov. 14, 2015) gives different numbers using 2013 VA databases.
Cascade of Care for Hepatitis C Virus Infection Within the US Veterans Health Administration (Link to abstract on PUBMED).
OBJECTIVES: We measured the quality of HCV care using a cascade of HCV care model.
We estimated the number of patients diagnosed with chronic HCV, linked to HCV care, treated with HCV antivirals, and having achieved a sustained virologic response (SVR) in the electronic medical record data from the Veterans Health Administration’s Corporate Data Warehouse and the HCV Clinical Case Registry in 2013.
Of the estimated 233,898 patients with chronic HCV, 77% (181,168) were diagnosed, 69% (160 794) were linked to HCV care, 17% (39,388) were treated with HCV antivirals, and 7% (15,983) had achieved SVR.
From the SFC’s report, “Prior to the virus’ identification in 1989, HCV was frequently spread through unscreened blood transfusions.”
Definitions and synonyms for the word “frequently”: all the time, habitually, very often, commonly, usually, as a rule, , ordinarily, again and again, over and over, repeatedly, regularly, routinely, more often than not and other none precise terms which sometimes can be quantified. Pick your favorites. I like “more often than not” and “all the time.”
The military had been working on the hepatitis-transfusion problem decades before the “Vietnam Misunderstanding” as Nod sometimes puts it. But the technologies had to be developed before anything could be done to break the chain of transmissions as each hepatitis virus was identified.
Korean War transfusions. Image: Walter Reed.