Study: Combat a possible risk factor for hepatitis B

To what extent does military exposure, including time in combat, put someone at risk for acquiring hepatitis B? The virus causes a liver infection that, if not treated properly, can lead to serious health consequences, such as cirrhosis—a deterioration of the liver—liver cancer, or even death.

A new study of Veterans has found prevalence of hepatitis B to be greatest among those with traditional risk factors, such as drug-use or high-risk sexual practices, but also suggests that combat exposure can be a risk factor on its own. Hepatitis B can be acquired, for example, by being wounded or making contact with infected blood when a fellow service member is wounded.

Dr. Lauren Beste, an internist at the VA Puget Sound Health Care System and an official in VA’s HIV, Hepatitis, and Related Conditions Program Office, led the research. She believes the study, which recently appeared in the journal Clinical Gastroenterology and Hepatology, is the first to gauge the prevalence of hepatitis B in relation to combat.

The study included 1,146 Veterans who received VA care from 1998 to 2000. Beste and her team found that evidence of hep B exposure was highest among Veterans with traditional risk factors, such as drug use or high-risk sexual practices. Of these people, 60% reported a history of combat exposure. After adjustment for demographic and traditional risk factors, the researchers determined that service in a combat zone and being wounded in combat were independently associated with exposure to hepatitis B.

The study team concluded that more research is needed to determine whether Veterans who were in combat prior to the era of universal vaccination should be screened for exposure to hepatitis B. The military began vaccinating all service members for the disease after 2000. Vets who have served after that point are presumed to be vaccinated and thus protected from the virus.

“There are many important reasons to study whether military exposures are linked to hepatitis B. One is to make sure we offer screening to Veterans who could be at risk.”

“The hepatitis B virus has effective treatments and can be identified with a simple blood test, but military service is not one of the risk factors that is traditionally used to prompt screening,” says Beste. “There are many important reasons to study whether military exposures are linked to hepatitis B. One is to make sure we offer screening to Veterans who could be at risk. Another is to give Veterans a chance to apply for VA compensation if their hepatitis B is related to military service.”

It’s important to note that the study does not show cause and effect, only a link between combat and hepatitis B. The researchers can’t prove definitively that any case of hep B came about because of a combat wound or contact with infected blood in a combat setting.

“As a physician,” says Beste, “my job is to identify who needs to be screened for hepatitis B, regardless of the way the hepatitis B exposure may have occurred. From a practical standpoint, Veterans with combat history do appear to have an increased risk for hepatitis B exposure.”

The hepatitis B virus is transmitted when people come in contact with the blood or bodily fluids of someone else who has the virus. This most often happens through sexual contact or the sharing of needles, syringes, or other drug-injection equipment; or from mother to baby at birth.

Hepatitis B can be either acute, generally meaning the virus will leave a person’s body within the first six months, or chronic, in which case it never goes away, even if treated. “It’s important to identify the people at risk in order to treat them and hopefully prevent the long-term consequences of the disease,” Beste says.

The three most common types of viral hepatitis are A, B, and C. Of the three, hepatitis C is most prevalent among Veterans. VA has treated some 120,000 Veterans infected with hepatitis C; more than 100,000 have been cured, thanks to newer drugs.

Beste points out that “outside of the United States and other developed nations, hepatitis B is much more common than hepatitis C and far surpasses hepatitis C as a cause of liver cancer and liver-related deaths. The hepatitis B infection is a global health care problem, especially in developing areas.”

Unlike hepatitis C, hep B is not curable. In that sense, it’s like HIV. “You can suppress it, but you can almost never get rid of it once you’re chronically infected,” Beste says. “In most cases of hepatitis C, you can take pills, and it’ll be totally gone from your body.”

Photo at top: Navy Veteran Natale Stella (right) served on two aircraft carriers during the Vietnam War. He has lived with hepatitis B for two decades, and undergone treatment with antiviral medications to keep the virus in check. He is seen here with Dr. Lauren Beste on the campus of the VA Puget Sound Healthcare System. (Photo by Christopher Pacheco)