The Department of Veterans Affairs (VA) health system appears on track to cure hepatitis C in more than 100,000 former United States military members within a matter of months—enough to potentially eliminate the disease in this high-risk group, according to a VA news release.
“As the largest single provider of HCV care in the U.S., this is terrific news because it means we are within striking range of eliminating hepatitis C among veterans under the care of the Veterans Health Administration,” said VA Secretary Robert Wilkie. “Diagnosing, treating and curing hepatitis C virus infection among veterans has been a significant priority for VA.”
Compared with the overall population, veterans have a higher prevalence of hepatitis C virus (HCV)—as high as 5 percent, or about triple the general population rate, according to some studies. The rate is especially high among baby boomers born between 1945 and 1965, which includes Vietnam War veterans.
Thanks to the advent of highly effective oral direct-acting antivirals (DAAs), almost everyone treated for hepatitis C can now be cured with well-tolerated medications taken for just two or three months. More than 90 percent will achieve a sustained virological response, meaning undetectable HCV at the end of posttreatment follow-up, and those not cured on the first try will generally succeed with further attempts.
Despite the availability of effective treatment, many people with hepatitis C in the general population have not been cured because of barriers such as a lack of awareness, inadequate screening, a shortage of providers and the high cost of the drugs. But the VA—which provides consistent free or affordable care for veterans and maintains extensive electronic health records—offers the opportunity to overcome these barriers.
The first DAA drug, Sovaldi (sofosbuvir), was approved in December 2013. Before 2014, only 12,000 of the approximately 180,000 veterans with chronic HCV under the care of the VA had been treated and cured using interferon-based therapy, which was often poorly tolerated and much less effective than DAAs.
As of the beginning of March, nearly 116,000 veterans currently under VA care had started DAAs, according to the announcement. Of these, 96,654 (83 percent) have already completed treatment and been cured. The remainder of those now on treatment will finish within two to three months, and the vast majority of them will be cured. Currently, fewer than 27,000 veterans under VA care still need treatment. By October, the VA expects to have treated more than 125,000 people.
These results are the outcome of an aggressive program to identify all undiagnosed veterans with hepatitis in the VA system, link them to HCV care and offer them treatment with DAAs. At the peak of this effort, the VA was treating close to 2,000 veterans for HCV every week, with nearly one person starting DAAs every minute of every work day, according to the announcement.
Over years or decades, chronic HCV can lead to severe liver disease including cirrhosis (scarring), liver cancer, end-stage liver failure and the need for a liver transplant. As a result of the VA’s treatment effort, the overall death rate for veterans with hepatitis C under VA care fell by 80 percent a year after treatment, and the likelihood of developing liver cancer decreased by 84 percent, the announcement said.
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