In the Journals

Vietnam era vets may not be at higher risk for HCV than nonvets

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April 4, 2014

Vietnam War era veterans did not report a higher prevalence of common hepatitis C risk factors — including injection drug use — compared with nonveterans, but they may have faced risk factors specific to their military service, according to new study data.

“Vietnam era veterans may have other HCV exposure risk factors in their history, other than injection drug abuse,” study researcher Joseph A. Boscarino, PhD, MPH, a senior scientist at Geisinger Health System Center for Health Research in Danville, Pa., told Infectious Disease News. “Most important, they do not appear to have higher rates of injection drug abuse than comparable nonveterans. Also, a number of these vets report they got HCV through their military service during the Vietnam War era. We don't know if this is true or not, and more research may be required to answer this question more definitively.”

Joseph A. Boscarino, MD, MPH 

Joseph A. Boscarino

Previous studies suggest that Vietnam era veterans have higher rates of HCV infection, which is attributed to a greater prevalence of injection drug use. However, the researchers said most of these studies have been conducted among patients in the Department of Veteran Affairs health care system, which most veterans do not use. Patients that use the VA health care system also tend to be different demographically.

To assess HCV risk factors among Vietnam era veterans vs. nonveterans, Boscarino and colleagues surveyed 4,636 HCV patients who received care in four health care systems outside the VA. Among the male respondents (n=2,638), 22.5% served in the US military at some point from 1964 to 1975. These Vietnam era veterans were more likely to be older (P<.001), more educated (P<.001), less often foreign born (P=.009), and more often married (P<.001) vs. nonveterans.

Vietnam era veterans actually had a lower prevalence of injection drug use compared with nonveterans (54% vs. 58%; P=.16). Other common risk factors for HCV infection, including occupational risk factors (P=.18), medical procedures (P=.61) and blood transfusions or organ transplantations (P=.94), were not more common among Vietnam era veterans. The researchers found that nonveterans were more likely than veterans to report sex with men (P=.013) as a risk factor for infection, but the prevalence was low (2.4% vs. 0.6%).

Analyses indicated that Vietnam era veterans were more likely to report “other” risk factors as the source of their infection (P<.001) — namely, exposure to vaccinations during their military service. The researchers said that during the Vietnam War era, service members received multiple injections, typically with pneumatic injectors, as they moved through vaccination lines, and bleeding was not uncommon. This method of vaccination was later phased out by the military.

Although more research is needed, Boscarino said clinicians can play an important role in the management of HCV in veterans.

“Clinicians need to be aware that the VA will provide disability compensation for vets for HCV, if the vet can submit a supportable claim to the VA for HCV infection related to military service,” Boscarino said. “In some cases, clinicians may be able to help vets submit a claim to the VA related to their particular case. Ultimately, this may be difficult because these potential exposures occurred decades ago, but the veterans will appreciate this support from clinicians.” – John Schoen

Disclosure: See the study for a full list of financial disclosures.