askthedoctor Hepatitis H New Hope for
Hepatitis C A late February VA rul- ing extends coverage of hepatitis C treatment to all enrolled veterans, re- gardless of stage of liver disease. MOAA cosigned a letter from the Vietnam Veterans of America re- questing coverage.
50 MILITARY OFFICER APRIL 2016
Not a specifi c disease, but rather a condition — infl ammation of the liver — hepatitis has several causes, including viruses such as hepatitis A, B, and C. By Rear Adm. Joyce Johnson, D.O.
Hepatitis, or inflammation of the liver, has many causes, including exces- sive alcohol, medication complications, and viruses. Many cases of viral hepatitis have no symptoms. Symptoms of acute hepatitis might include jaundice (yellowing of skin and eyes), abdominal pain, loss of appetite, nausea, vomiting, diarrhea, and fatigue. Chronic hepatitis can occur over several decades and result in fi brosis, cirrhosis, and liver cancer; it can be fatal. Hepatitis A, B, and C are viral forms of hepatitis. Hepatitis A is spread by oral-fecal con-
tact. In young children, it has no symptoms, but it can spread to others (e.g., parents) who haven’t had the disease, who then will have symptoms. In some developing countries, nearly all children get hepatitis A. In the U.S., the hepatitis A vaccine is recommended for young children as well as adults at high risk. Acute infection with hepatitis A results in lifelong immunity. Hepatitis B is transmitted through in- fected blood and body fl uids. In many cases, the disease is self-limited, and the patient develops lifelong immunity; others become lifelong carriers and can spread the infec- tion. Carriers also are at risk for cirrhosis, liver cancer, and other long-term complica- tions. The hepatitis B vaccine can prevent initial infection, but it will not aff ect the car- rier state. Antiviral treatment can slow viral growth in an infected person but will not cure the hepatitis B infection. Hepatitis C, also transmitted through in- fected blood and body fl uids, is the leading
reason for liver transplants in the U.S. The Centers for Disease Control and Prevention estimates about 30,000 people a year in the U.S. are infected with hepatitis C. About 75 to 85 percent become chronic carriers; up to one-fi fth of chronic carriers will develop cirrhosis, and for some it will be fatal. About 2.7 million people currently are chronic carriers — many infected via blood transfu- sions before 1992, before tests to screen do- nors for hepatitis C were available. Because hepatitis C usually has no symptoms until late in the carrier stage, many people don’t know they are infectious. There is no vaccine for hepatitis C, but
treatment often can “cure” the viral infec- tion, so the virus is no longer detectable. Sofosbuvir recently was approved by the FDA to treat hepatitis C infection. It is used in combination with other drugs, with the specifi c regimen dependent on the viral genotype and other factors. Though eff ec- tive in ridding the body of the virus with far fewer side eff ects than older treatments, the new drug regimen is expensive. Be- cause many Vietnam War veterans carry hepatitis C, DoD and the VA are prioritiz- ing use of the new regimen. Though medi- cation can eliminate the virus from the body, many chronic eff ects on the liver, such as fi brosis and cirrhosis, remain.
MO
— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more information about health care options at
www.moaa.org/wellness. For submission information, see page 6.
PHOTO: STEVE BARRETT
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