Following a recent milestone in curing the hepatitis C virus, the Department of Veterans Affairs is now focused on detecting liver disease prevalent among veterans that can persist even among patients who have taken the hepatitis cure.
On World Hepatitis Day earlier this month, the VA announced it had cured more than 100,000 veterans of the chronic hepatitis C virus infection (HCV), which can lead to advanced liver disease (ALD).
"Curing HCV can prevent the development or progression of ALD," the VA said in a news release, adding that "currently, fewer than 25,000 veterans in VA care remain to be treated" with an eight- to 12-week oral regimen of the drugs Sovaldi and Mavyret.
Through early June, the VA reported spending a total of $814 million on medications to treat HCV.
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However, recent studies have shown that liver disease, particularly non-alcoholic fatty liver disease (NAFLD), can persist among patients even after they undergo the drug regimen for hepatitis C.
A study published last year in the World Journal of Gastroenterology showed that fatty liver was present in more than 47% of the patients who had taken the hepatitis C cure.
According to the VA, non-alcoholic fatty liver disease "occurs most often in people with high blood sugar, obesity, or high cholesterol" and is the most common chronic liver disease in the U.S.
"While the new drugs can effectively eradicate hepatitis C in many patients, liver disease remains and the individuals still require ongoing monitoring for NAFLD," said Dr. Stephen A. Harrison, a retired Army colonel and medical director of Pinnacle Clinical Research in San Antonio.
The VA currently is using FibroScan portable ultrasound devices, made by the tech firm Echosens, to monitor for fatty liver disease and its sub-type, non-alcoholic steatohepatitis (NASH). Harrison said he uses FibroScan in his own practice on a daily basis.
FibroScans shoot waves of sound into the liver to measure its stiffness, an indicator of the two conditions, said Harrison, also a visiting professor of hepatology in the Radcliffe Department of Medicine, University of Oxford.
FibroScans have been approved by the Food and Drug Administration and can help detect liver disease before it progresses, but there is as yet no FDA-approved treatment for non-alcoholic fatty liver disease or the sub-type, he said.
Patients with liver disease are advised to lose weight, exercise and avoid the intake of drinks with high levels of fructose, Harrison added.
In 2017, the VA signed a $47 million contract to acquire FibroScans from Echosens, said Dustin Lee, president of Fidelity Sustainment Distribution LLC, which joined with Echosens in the deal.
The great advantage of the FibroScans is that they allow veterans to avoid the invasive and sometimes painful biopsies often used to detect liver disease, said Lee, a former Marine corporal and scout/sniper who served in Afghanistan.
"The FibroScan technology has been a valuable tool in this fight, and has truly helped many of my veteran brothers and sisters at the VA," he said in a statement.
-- Richard Sisk can be reached at Richard.Sisk@Military.com.