In the Battle Against Hepatitis C, the VA Takes the Lead

Junius Wilson likes to dress up when he goes in for his appointments at the Department of Veterans Affairs in Martinez. On a recent visit, the 67-year-old wore a black felt fedora and a sport coat. On his lapels, he wore a handful of military medals.

"All these are medals from Vietnam," he said. "The three stars are for warriors ... this one's national defense."

Wilson's wife, Shelly Baker, sat beside him. She nudged him to show off one medal, which hung from a violet ribbon: a Purple Heart.

Wilson got that one because he was shot in the foot diving for cover during battle. He was in the infantry in South Vietnam and saw a lot of combat.

But Wilson, 67, isn't here for that. He's come for a monthly consultation with a specialized VA nurse who oversees his hepatitis C treatment.

The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus.  Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers.

While about 1 percent of the U.S. population is infected with hepatitis C, veterans who use the VA have higher rates, 4.8 percent.

And Vietnam-era veterans like Wilson have an even higher rate, according to studies, VA data and physicians. Not all Vietnam veterans use the VA for health care, but among those who do, 7.5 percent have tested positive for the virus.

It's unclear why, but there are several theories. One is simply the demographic overlap between Vietnam veterans and baby boomers. Members of the baby-boom generation have Hepatitis C infection rates  five times higher than the average American. Hepatitis C, which is blood-borne, wasn't even identified as a distinct virus until 1989, and the baby boomers grew up in an era when blood wasn’t screened, and before disposable needles were common in medical settings.

Some attribute the higher rate of Hepatitis C in Vietnam veterans to the injections they received before deploying: Troops sent to Vietnam were often vaccinated assembly-line style, with something called a jet injector. Instead of a needle, a jet injector uses high pressure to force a vaccine through the skin. Later, research showed that older versions of the device could transmit a hepatitis virus from person to person, and it's no longer used in the military. While it is impossible to know if jet injectors spread the hep C virus, the VA has said it is "biologically plausible."

Others point out that some veterans of this conflict used intravenous drugs while in Vietnam, or after returning to the U.S.

Hepatitis C is passed through the blood. About 3.5 million Americans have the virus, and it's believed that half of them do not know it. After the discovery of the virus in 1989,  screening of the blood supply didn't begin until 1992.

The virus can lurk silently for years, slowly damaging the liver until symptoms appear, like pain, nausea and yellow skin. It kills more Americans than all other infectious diseases combined, including HIV.  In 2014, the death toll reached an all-time high of 19,659.

The VA's push to find -- and cure -- every patient with the virus began three years ago.

This became feasible only when new hepatitis C medications came to market in late 2013. The new generation of drugs was  a huge improvement over previous treatments. The older drugs required shots that were injected into the stomach, and the medications could have severe side effects: flulike symptoms and even mental health problems.

VA nurse Susan Bertilacchi-Green does not miss those days. A decade ago, the cure rate she observed from those older drugs was about 30 percent, she said.

"That was then," she said. "Now, we have new medications that are nearly 100 percent effective. They have little to no side effects. You can be treated in as little as eight weeks, and there's no shots anymore."

Since 2014, the VA has cured 96,000 patients of hepatitis C.

Vietnam veteran Roman Walden is one of them. He thinks he got the virus while injecting heroin in Vietnam, a habit that continued  when he returned home to Oakland. Years ago, he tried treatment on the old drugs, but had to stop due to serious side effects. When the new drugs came out, he was hesitant to try treatment again. But with reassurance from Bertilacchi-Green, and other veterans who'd been cured, he yielded. This time, the treatment worked.

"I was really amazed at that," he said. "But then what really got me was how much it cost, and that made me feel like the president of the United States. They were spending this much money on me?"

Hepatitis C drugs have become notorious for their high cost. The wholesale price for a course of treatment can be over $100,000.

For Walden, that high price actually prompted him to take himself more seriously. He said the expense felt like an investment in him by the VA. After years on and off drugs, and in and out of jail, Walden, now 62, said he’s finally changing for the better. He said he no longer drinks or uses drugs, and is volunteering in hospitals, playing drums for patients.

The exorbitant prices of the new hepatitis C medications have led other health plans to hold off on treating every patient. Medi-Cal, for example, gives treatment priority to patients that show evidence of liver damage, or those who could spread the virus, like active drug users.

While the VA initially also had "treatment priorities," this policy changed in 2016, after Congress stepped up with billions in funding, and pharmaceutical companies released new versions of drugs that were more competitively priced.

These days, the VA will treat anyone with any level of veterans benefits. For the veterans, the treatment is usually free. Some have a small co-pay for the entire course of treatment, with $33 as the maximum.

Health officials say hepatitis C could be eliminated as a public health risk by 2030, but it will happen only if other health plans copy the VA’s lead.

At the VA in Martinez, Bertilacchi-Green concludes the visit by showing Junius Wilson and his wife, Shelly Baker, his latest lab tests. Even though he still has a month to go on his medication, the virus is already undetectable in his blood.

Wilson and Baker smile at one another.

"We're happy," Baker said. "We still need him around for a long time."

Additional reporting by Carrie Feibel.