Hepatitis C in veterans

Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States and has recently been identified as the single most important emerging pathogen in the Department of Veterans Affairs (VA) health care system. The Third National Health and Nutrition Examination Survey estimated that 3.9 million Americans (1.8%) are infected with HCV. In contrast, the prevalence is much higher (6.6% to 51.0%) among veterans receiving care at VA facilities. The prevalence of HCV is highest among Vietnam veterans, and injection drug use is the most common mode of transmission. A significant proportion of veterans are not candidates for treatment with currently available antiviral medications due to comorbid psychiatric and substance abuse disorders. Furthermore, the limited data available on the treatment of HCV in veterans suggest that the sustained virologic response to current antiviral therapies is lower than in nonveterans. Treatment and management of HCV will be a challenge for the VA health care system, and additional studies to evaluate the epidemiology, treatment, and outcomes of veterans with HCV are warranted.