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Spectrum of disease in U.S. veteran patients with hepatitis C
Huy A Nguyen1, April I Miller, Eric Dieperink
1Department of Medicine, Veterans Affairs Medical Center, University of Minnesota, Minneapolis 55417, USA.
Insights
Hepatitis C virus (HCV) infection is common in veterans, often co-occurring with psychiatric and substance abuse issues. Advanced liver disease is prevalent, highlighting the need for integrated medical and psychiatric care.
Area of Science:
- Hepatology
- Infectious Diseases
- Psychiatry
- Public Health
Background:
- Hepatitis C virus (HCV) infection disproportionately affects U.S. veterans.
- Co-occurring psychiatric and substance abuse conditions are common in this population.
Purpose of the Study:
- To investigate risk factors, psychiatric and substance abuse conditions, and liver disease severity in veterans with HCV.
- To evaluate treatment outcomes for HCV in a veteran cohort.
Main Methods:
- Review of medical records and liver biopsies for 206 HCV-infected veterans eligible for interferon therapy.
- Analysis of demographic data, risk factors, psychiatric diagnoses, substance abuse history, and liver disease severity.
Main Results:
- The majority of veterans (89%) had psychiatric and/or substance abuse diagnoses.
- Severe fibrosis (32%) and inflammation (71%) were common.
- Interferon-based treatment was prescribed to 71%, with sustained virological response rates of 16% (monotherapy) and 28% (combination therapy).
Conclusions:
- Advanced fibrosis is frequent in veterans with chronic hepatitis C.
- Integrated care models are crucial for managing HCV in veterans with complex comorbidities.
- Multidisciplinary clinics facilitate treatment delivery for this population.
Objective:
Hepatitis C virus (HCV) infection is more prevalent in U.S. veterans attending Veterans Affairs Medical Centers than in the general population. The purpose of this study was to examine the risk factors, psychiatric and substance abuse conditions, and severity of liver disease in veterans with HCV.
Methods:
The medical records and liver biopsies of 206 consecutive patients with HCV attending a multidisciplinary medical/psychiatric chronic hepatitis clinic and who met eligibility criteria for interferon alpha-2b therapy were reviewed.
Results:
The mean age was 46.5+/-6.8 yr and 77% were Vietnam-era veterans. Risk factors included i.v. drug use (64%), blood transfusion (15%), and cocaine use (9%), and were unknown in 12%. The average estimated duration of disease was 24+/-7.6 yr. A history of alcohol abuse or dependence was identified in 80% of patients. Psychiatric illnesses were present in 60%, the most common being depression and posttraumatic stress disorder. Overall, 89% of patients had documented psychiatric and/or substance abuse diagnoses. Severe fibrosis (stages 3-4) was present in 32% and severe inflammation (grades 2-3) was present in 71% of biopsies. Psychiatric and substance abuse diagnoses did not correlate with severity of liver disease. A total of 145 patients (71%) were prescribed interferon-based treatment. The overall virological sustained response rates were 16% after interferon monotherapy and 28% after interferon/ribavirin therapy. Reasons for not receiving interferon therapy included minimal fibrosis on liver biopsy (37 patients [18%]), worsening medical conditions (nine [4%]), and worsening psychiatric and substance abuse problems (14 [7%]).
Conclusions:
Advanced fibrosis is common in this cohort of veteran patients with chronic hepatitis C, and the overwhelming majority of these patients have psychiatric and/or substance abuse diagnoses. Despite these comorbidities, the majority received interferon therapies in the context of a multidisciplinary clinic. These data emphasize the importance of hepatitis C care that includes linkage of medical care and psychiatric services.