DANVILLE - A team of researchers from four health systems across the United States has published a study revealing that Vietnam era vets with hepatitis C virus (HCV) do not have higher rates of this disease due to injection drug abuse compared to nonveterans. The study was published electronically in the Journal of Community Health in April.
It is estimated that 3.2 million Americans have chronic HCV infections, and compared to HIV, the medical community knows little about the spectrum of the disease, access to care and the effectiveness of current therapies.
The purpose of the current study was to assess reported risk factors for HCV among U.S. Military veterans from the Vietnam era compared to nonveterans. Past studies among mostly Veterans Health Administration (VA) medical facility patients have suggested that Vietnam era veterans have a higher prevalence of the infection primarily due to higher rates of injection drug abuse, a known risk factor for HCV infection.
"The issue of hepatitis C and its link to Vietnam veterans has been a sore issue with these veterans for at least a decade," said study author Dr. Joseph Boscarino, a senior scientist with the Geisinger Health System Center for Health Research and study site director at Geisinger. "We decided to take a different approach and study patients who sought treatment outside of the VA. Since previous veteran studies typically looked at patients treated in VA facilities, our hypothesis was that Vietnam era veterans do not have higher rates of this disease to due drug abuse than nonveterans.
"Since most veterans do not use the VA healthcare system and studies of Vietnam veterans in the community have suggested that they actually had lower rates of drug abuse than nonveterans, we were confident of our hypothesis," Boscarino added.
Boscarino's study analyzed records of more than 2 million patients to obtain a random survey of 4,636 patients with laboratory-confirmed HCV disease. A total of 2,633 male respondents with HCV infection were included in his analyses. Females with HCV were excluded from these analyses, because less than 2 percent were veterans. The final analysis included 526 Vietnam era veterans (those who served in the military anytime between 1964 and 1975), compared to 1,812 non-veterans. The comparison yielded no major common risk factors pointing to a Vietnam era link to hepatitis C infection.
"Of all the known risk factors associated with hepatitis C, including injection drug use, occupational exposures, sexual contacts or blood transfusions before 1992, there was little to no variation between how Vietnam era veterans and nonveterans reported contracting HCV infection," said. Dr. Boscarino. "The one exception, however, was that the veterans were significantly more likely to report they got their HCV infection though 'other' sources, than the nonveterans. When asked what these 'other' sources were, vets typically reported they were 'shots' or 'vaccinations' they received in the military.
"While the issue of 'shots' or 'vaccinations' received in the military being the cause of HCV infection among Vietnam vets is yet to be proven, it is clear that the most significant risk factor having a history of injection drug abuse is not higher among the vets seen outside of the VA, compared to nonveterans. Further research is clearly warranted."
Funded by the Centers for Disease Control and Prevention Foundation, the study utilized clinical and survey data from patients of four non-VA health care providers: Geisinger Health System, Danville,; Henry Ford Health System, Detroit, Mich.; Kaiser Permanente-Northwest, Portland, Ore.; and Kaiser Permanente-Hawaii, Honolulu.