My, my, my–what a difference a few years and the new direct-acting antiviral (DAA) make in influencing public health policy. In 2013, the U. S. Preventive Services Task Force (USPSTF) HCV recommended one-free screening for Woodstock-loving Baby Boomers born between 1945 and 1965. Now USPSTF (LINK) recommends that ALL adults ages 18-79 get screened:
Patient Population Under Consideration
This recommendation applies to all asymptomatic adults without known liver disease.
The public commenting period has closed. The CDC has not updated/reviewed their HCV page (LINK) since October 15, 2015 as of today.
HCV is still transmitted by dirty injections including by drug diversions, a criminal form of “health-care associated” infections. In a recent case from Utah, a former nurse pleaded guilty of infecting seven of her patients in a plea deal. During the free screenings offered by the hospitals that employed the nurse, 37 more cases had been identified but many with different strains.
Historic health-care associated routes for HCV transmission are still played down in the veteran populations–most notably exposures via vaccinations by the jet injectors. There are acknowledged cases of HCV transmission by multi-vial misuse, routine injections, and surgical and dental procedures in medical literature regarding veterans.
The official VAntage Point blog published a rare sympathetic 2015 post by VA employee Terry R. Bentley (LINK) entitled Treating Hepatitis C: One Vietnam Veteran’s story (LINK ) in which the veteran discusses the “air guns” and his exposure to blood in combat situations.
A new type of “choice” for veterans
But there is a health-care associated route for HCV transmission that is being adopted by veterans in dire need of new kidneys–the transplantation of kidneys which are HCV-positive. Facing death or transplantation with a HCV-positive kidney followed by HCV treatment afterwards, some vets are opting in, risks aside. Dr. Daniel Katz (LINK) said,
“The high cost of hep C treatment may hinder rapid adoption of this practice in the private sector, where the transplant center may not be reimbursed for the hep C treatment… even with the hep C treatment, though, there will be cost savings over time by removing patients from dialysis.”
Some VA transplant centers may also be able to offer HCV-positive livers and hearts to some veterans. This seems counter-intuitive but might give someone many more years of life. Time will tell.
About HCV, the Utah Department of Health states, “It is extremely contagious and can be spread by people who have no symptoms.” (LINK) Besides being “extremely contagious” the way this virus changes and hides in human tissues, besides liver tissues, is going to be the subject of ongoing research for years. As is the search for a vaccine to provide long-term immunity.