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May 2014 VA Hep C Treatment Guidelines
UPDATE: Feb 26, 2016-
Funding and Prioritization Status Update

UPDATE: March 2016
VA Hep C Treatment Guidelines
VA to treat all vets in system

By Judith Graham
VA Extends New Hepatitis C Drugs to All Veterans in Its Health System

Orange Count Registry
Vietnam vets blame 'jet guns' for their hepatitis C
By Lily Leung Feb. 14, 2016 
CBS News Investigates
Congress outraged over hepatitis C treatment VA can't afford
Dr. Raymond Schinazi played a leading role developing a drug that cures hepatitis C while working seven-eighths of his time for the VA| By amynordrum

Hepatitis C drug costing VA, DoD millions
By Patricia Kime, Staff writer
We're looking at a company who is milking a cash cow for everything it's worth," Sanders said. 

VA to outsource care for 180,000 vets with hepatitis C
Dennis Wagner, The Arizona Republic 12:27 a.m. EDT June 21, 2015

VA to outsource care for 180,000 vets with hepatitis C
, The Republic | 11:51 a.m. MST June 19, 2015
Dr. David Ross, the VA's director public-health pathogens programs, resigned from the working group. "I cannot in good conscience continue to work on a plan for rationing care to veterans," he wrote.

VA Region Stops Referring Patients To Outside Hospitals Thanks To Budget Shortfall
Michael Volpe Contributor ...According to a memo — the entire region has been forced to stop all “non-VA care” referrals due to a budget shortfall.
Sen. Mark Kirk admitted the VA Choice Program is a failed joke in a letter to Secretary Bob McDonald despite attempts to fix it.

Denied Hep C VA dental care?
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Dried Hepatitis C Blood Exposure 11/23/2013 Weeks later inconspicuous blood transmits virus and more likely to cause accidental exposures to Hep C

Lack of Standards for
Mass Vaccinations
1970 Jetgun Nursing Instructions

2014 AASLD Study Hepatitis C not an STD

Test the Rest Campaign
Documentation & Surveillance Alerts
Military Hepatitis History  
Understanding The Liver 
VA Flow Sheet for Cirrhosis
VA Defines Risk Factors
Hep C & Pro-Prebiotic
Need to know-Grassroots Research
Blog Another12Weeks
One Vets' Journey Though Treatment

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 What Would Veterans Do?
Blog for VA Claims

Help with VA Claims

Info: Plan Backfires-
VBA Fast Letter Boost Claims
Legal- Fed Regs state:
Judge decision may be relied upon
Cotant v. Principi, 17 Vet.App. 116, 134 (2003),
Service Connected Claims
# 1 Conclusion of Law 
# 2 Conclusion of Law 
More Claims
Jetgun Decisions
Hep C Decisions
Search Board of Appeals Website
BVA Jetgun Decisions
BVA Hepatitis C Decisions

Great Advice!  
After the jetgun win
What to do next



Hepatitis C Genotypes and Quasispecies

Hepatitis C Virus Genotypes

An important variable for all patients with chronic hepatitis C virus (HCV) is the "genotype" of HCV with which they are infected. This is the strain of the virus to which they were exposed when they were infected, often many years prior to their evaluation, and it is determined by a simple blood test. Genotypes of HCV are genetically distinct groups of the virus that have arisen during its evolution.(1) Approximately 75% of Americans with HCV have genotype 1 of the virus (subtypes 1a or 1b), and 20-25% have genotypes 2 or 3, with small numbers of patients infected with genotypes 4, 5, or 6.(2) Most patients with HCV are found to have only one principal genotype, rather than multiple genotypes.(3, 4, 5) Genotype 4 is much more common in Africa than in many other parts of the world, genotype 6 is common in Southeast Asia, and each area of the world has its own distribution of genotypes.(6)

Clinical Significance of Hepatitis C Genotypes

Genotype generally has not been found in epidemiological studies to play a large role in liver disease progression due to HCV. Rather, genotype is of clinical importance principally as a factor in response to HCV treatments. With all treatments tested to date, patients with genotypes 2 and 3 are more than twice as likely as patients with genotype 1 to achieve a sustained virological response to therapy.(2, 3, 4 ,5, 7) In addition, when using combination therapy with interferon and ribavirin, patients with genotypes 2 or 3 generally are treated for only 24 weeks, whereas it is recommended that patients infected with genotype 1 receive treatment for 48 weeks.

Quasispecies and Viral Mutation

Within all individuals, slightly different genetic versions of their genotype are present. Viral mutations occur over time spontaneously and in response to pressure from the host immune response, forming genetically distinct viral groups called quasispecies.(1) Genotypes represent major genetic differences, whereas quasispecies represent minor genetic differences within an individual. Quasispecies continue to evolve in an individual over time, whereas genotype does not change. Quasispecies can be measured quantitatively (viral complexity) and qualitatively (viral divergence over time).

Clinical Significance of Quasispecies

HCV quasispecies are of research interest, but their measurement has not yet been directly applicable to HCV management or treatment. An example of the significance of quasispecies is that, in acute HCV infection, isolates develop little genetic diversity in a particular region when they produce self-limited hepatitis, whereas they develop greater genetic diversity in the setting of persistent infection.(8) Thus, the dynamics of quasispecies evolution during acute infection may reflect the future course of infection. Quasispecies diversity also has been found to be stable or to increase in patients being treated with interferon and ribavirin who do not respond to therapy, whereas it decreases in responders.(9) HCV variants also can be used to prove linkage of infections that are associated epidemiologically. For example, molecular analysis has been used to link mother/infant pairs, to define HCV in apparently concordant sexual couples as virologically concordant or discordant, to prove nosocomial transmission of HCV between health care provider and patient, and to link needlestick recipients with the sources of infection.(10)


  1. Bukh J, Miller R, Purcell R. Genetic heterogeneity of hepatitis C virus: quasispecies and genotypesLink will take you outside the VA website.. Semin Liver Dis 1995;15:41-63
  2. McHutchison JG, Gordon SC, Schiff ER, et al. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C Link will take you outside the VA website.. N Engl J Med 1998; 339:1485-1492.
  3. Manns MP, McHutchison JG, Gordon SC, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomized trialLink will take you outside the VA website.. Lancet 2001; 358:958-965.
  4. Fried MW, Shiffman ML, Reddy R, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infectionLink will take you outside the VA website.. N Engl J Med 2002; 347:975-982.
  5. Hadziyannis SJ, Sette H Jr, Morgan TR, et al. Peginterferon alpha-2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin doseLink will take you outside the VA website.. Ann Intern Med 2004; 140:346-355.
  6. Simmonds P. Genetic diversity and evolution of hepatitis C virus - 15 years onLink will take you outside the VA website.. J Gen Virol. 2004;85:3173-88.
  7. Zeuzem S. Heterogeneous virologic response rates to interferon-based therapy in patients with chronic hepatitis C: who responds less well?Link will take you outside the VA website.Ann Intern Med 2004; 140:370-381.
  8. Farci P, Shimoda A, Coiana A, et al. The outcome of acute hepatitis C predicted by the evolution of the viral quasispeciesLink will take you outside the VA website.. Science 2000;288:339-344.
  9. Puig-Basagoiti F, Forns X, Furcic I, et al. Dynamics of hepatitis C virus NS5A quasispecies during interferon and ribavirin therapy in responder and non-responder patients with genotype 1b chronic hepatitis CLink will take you outside the VA website.. J Gen Virol 2005;86:1067-1075.
  10. Gretch DR. Diagnostic Tests for Hepatitis CLink will take you outside the VA website.. Hepatology (Suppl.)1997;26:43S-47S.