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May is Hepatitis Awareness Month and should be noted as a milestone in the development of new and effective medications. Awareness about viral hepatitis is particularly important in Hawaii, where:
» 2 percent (one in 50) of Hawaii residents have hepatitis C virus in their blood.
» 5 percent (one in 20) of immigrants to Hawaii have hepatitis B virus in their blood.
» Hawaii has the highest rate of liver cancer in the United States.
» Liver failure due to cirrhosis is increasing rapidly among Hawaii residents.
But in Hawaii, we are also fortunate to have clinical research trials available at several centers that are bringing even newer medications to test and learn about with oversight of the Food and Drug Administration, and at no cost.
Recent reports from the national hepatitis meetings indicate tenofovir (Viread) and entecavir (Baraclude) are very effective for hepatitis B and with minimal resistance, even with single therapy. There will also be new medications available within weeks for hepatitis C that are dramatically different from the old therapies with interferon and ribavirin, which often made people sick for the year of therapy needed, and even then failed in half the cases.
They are called "designer" antiviral medications, as they have been developed with supercomputers and molecular biology. They will approximately double the usual response when given as an added pill and with little additional side effects.
Both telaprevir (Incivek) and boceprevir (Victrelis) are protease inhibitors, which stop the virus from replicating. They may be able to shorten the course of therapy needed for elimination of the virus and even appear to be effective for those who have failed treatment.
While the standard hepatitis C medications still have a lot of side effects, there are new studies that suggest combinations of new medications may not need interferon therapy.
These new medications seem quite effective in slowing or stopping the progression of the liver disease that causes cirrhosis and liver cancer.
Most people with viral hepatitis C or B do not even know that they have it. It is a silent epidemic with usually no acute symptoms with the initial infection. It may not be diagnosed for 20 to 30 years after the infection — when it surfaces with cirrhosis or liver cancer that may not be treatable.
Be aware of hepatitis and that it may be lurking in your friends or family — even you. The antiviral therapies for viral hepatitis and resources for diagnosis and treatment are improving dramatically. People should be screened or tested for these malignant viruses even though they may feel well.
If you or your family or friends have had a blood transfusion before 1992 or have ever been exposed to blood through unsterile needles or tattoos or medical instruments, get tested so we can stop this epidemic and the infection that may be incubating within. Ask your doctor to do blood or oral tests for hepatitis B, and C.
