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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
 
ibtimes.com| 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 | azcentral.com 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.
 

DisabledVeterans.org
OIG INVESTIGATES VA CHOICE PROGRAM PROBLEMS
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?
Please click here

 
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

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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 
 
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Conclusions: One in 4 chronic hepatitis C patients who start interferon and ribavirin treatment will develop an induced major depressive episode.
Interferon-Induced Depression in Chronic Hepatitis C: A Systematic Review and Meta-Analysis

Marc Udina, MD; Pere Castellví, PhD; José Moreno-España, MD; Ricard Navinés, MD, PhD; Manuel Valdés, MD, PhD; Xavier Forns, MD, PhD; Klaus Langohr, PhD; Ricard Solà, MD, PhD; Eduard Vieta, MD, PhD; and Rocío Martín-Santos, MD, PhD

J Clin Psychiatry 2012;73(8):1128-1138
10.4088/JCP.12r07694
Copyright 2012 Physicians Postgraduate Press, Inc.

Objective: To carry out a systematic review of the risk factors for, and incidence of, major depressive episode (MDE) related to antiviral therapy for chronic hepatitis C.
Data Sources: The MEDLINE, PsycINFO, and Cochrane databases were searched to locate articles published from the earliest available online year until June 2011 using the keywords hepatitis C, interferon-alpha,peginterferon, pegylated interferon, depression, and mood and Boolean operators. Articles written in English, Spanish, and French were included.
 
Study Selection: Prospective studies reporting incidence of interferon-alpha–induced MDE were included. At baseline, patients did not present a DSM-IV/ICD depressive episode, and evaluation was performed by a trained clinician. Twenty-six observational studies met the inclusion criteria.
Data Extraction: Extracted data included authors, year of publication, design, characteristics of the population, viral coinfection, adjunctive psychopharmacology, instruments to assess depression, dose and type of interferon-alpha, adjunctive ribavirin treatment, and follow-up time. Outcome of incidence of MDE (primary outcome measure) was abstracted, as were potential predictive variables.
Data Synthesis: A full review was performed. Meta-analysis of the cumulative incidence of induced MDE as a function of time was carried out. Odds ratios (ORs) and mean differences were used to estimate the strength of association of variables.

Results: Overall cumulative incidence of depression was 0.25 (95% CI, 0.16 to 0.35) and 0.28 (95% CI, 0.17 to 0.42) at 24 and 48 weeks of treatment, respectively. According to our analysis, high baseline levels of interleukin 6 (mean difference=1.81; 95% CI, 1.09 to 2.52), female gender (OR=1.40; 95% CI, 1.02 to 1.91), history of MDE (OR=3.96; 95% CI, 2.52 to 6.21), history of psychiatric disorder (OR=3.18; 95% CI, 1.60 to 6.32), subthreshold depressive symptoms (mean difference=0.96; 95% CI, 0.31 to 1.61), and low educational level (mean difference=−0.99; 95% CI, –1.59 to −0.39) were predictive variables of MDE during antiviral treatment.

Conclusions: One in 4 chronic hepatitis C patients who start interferon and ribavirin treatment will develop an induced major depressive episode. Clinicians should attempt a full evaluation of patients before starting antiviral treatment in order to identify those at risk of developing interferon-induced depression.
 

J Clin Psychiatry 2012;73(8):1128–1138
© Copyright 2012 Physicians Postgraduate Press, Inc.
Submitted: February 2, 2012; accepted March 28, 2012 (doi:10.4088/JCP.12r07694).
Corresponding author: Rocío Martín-Santos, MD, PhD, Clinical Institute of Neuroscience, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain, Villarroel, 170, 08036-Barcelona (rmsantos@clinic.ub.es).