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Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
1. Identify current risk factors for hepatitis C in veterans.
2. Apply risk factors to appropriate prevention and screening strategies
Background:
Although the prevalence of hepatitis C in veterans is higher than the general population, it is assumed that veterans were exposed to the disease many years ago. This study determines if veterans are still contracting hepatitis C.
Methods:
Retrospective review of all Department of Veterans Affairs patients in the Northwest tested two or more time for hepatitis C since 1994 who were initially seronegative. Cox proportional hazards model with time-dependent covariates was used to determine seroconversion rates and relative risks.
Results:
Of the 11,265 patients known to be hepatitis C seronegative at baseline, 251 (2.2%) became seropositive at some point during the follow-up interval. Although the overall sample seroconversion rate was 0.6% per year, certain subpopulations had substantially higher rates. Adjusted seroconversion risk was highest among individuals with opiate, cocaine or amphetamine use disorders (Relative Risk [RR] 4.0, Confidence Interval [CI] 3.0-5.5). Two other risk factors - repeatedly elevated ALTs (RR 2.4, CI 1.9-3.1) and prior hepatitis B exposure (RR 1.9, CI 1.4-2.5) - also significantly increased risk. Adjusted seroconversion rates for individuals with drug use disorders were 2% per year, while subpopulations with multiple risk factors demonstrated higher rates.
Conclusions:
Although most hepatitis C infections found in veteran populations are of unknown duration (but presumed chronic), there are definable subpopulations with substantial and clinically significant rates of recent seroconversion. Current VA practice standards provide no guidance on appropriate retesting intervals for seronegative individuals with ongoing risk, nor do significant primary prevention efforts exist. Annual or biennial retesting of individuals at risk should be strongly considered and opportunities for expanded primary prevention interventions sought.
See more of Poster Session #2
See more of The 2005 National Viral Hepatitis Prevention Conference