Prospects for recovery improve with new medicine

New drugs offer hope for a quicker, easier cure for the stealthy hepatitis C virus, which can linger undetected for decades before triggering liver cancer, a deadly ailment that is especially prevalent in Hawaii.

Baby boomers are five times more likely to be infected with hepatitis C than the general public, according to the Centers for Disease Control and Prevention. The federal agency advises all adults born between 1945 and 1965 to have a one-time blood test for it.

About 1 in 50 people in Hawaii have hepatitis C.

Many of them have no idea that they carry the virus because it often has no symptoms. As they get older, they are more likely to develop serious liver disease, including cirrhosis and cancer.

Hawaii has the highest rate of liver cancer in the country due to hepatitis B and hepatitis C, according to Dr. Daniel Saltman, an internist with the Waikiki Health Center.

"Hepatitis C treatment is on the cutting edge of medicine," said Saltman, course director for Viral Hepatitis Hawai’i, a symposium set for Saturday. "There are clinical trials with pill therapies that are very promising. Nobody used to talk about cures, and now people are talking about cures. It’s so exciting."

Traditional treatment for hepatitis C had been grueling — lasting as long as 48 weeks — with a regimen of pills and injections of interferon that cause depression and flu-like symptoms. Often the medicine would not work. But that is changing.

New medicines approved in 2011, administered in conjunction with interferon, have boosted cure rates to as high as 80 percent and cut the typical length of treatment to 24 weeks, Saltman said. Last month, a committee that advises the Food and Drug Administration recommended approval of two more drugs, simeprevir and sofosbuvir, which have fewer side effects and equal or better cure rates, he said. And there is hope for a pill-only treatment.

The symposium, sponsored by the Hepatitis Support Network of Hawai’i, will give an update on the state of viral hepatitis in the islands and promising treatments in the pipeline. It will be held at the Queen’s Conference Center.

Electronics engineer Tim Fedorka of Honolulu discovered he had hepatitis C when trying to get life insurance in 1991 as his wife was having their second child. He had no symptoms, but his liver enzymes were elevated.

Over the years, he has gone through three different courses of treatment in the ever-evolving world of hepatitis medicine, an emotional and physical roller coaster marked by anger, depression and side effects similar to those of chemotherapy.

"It was really horrible," he said. "My wife said I looked like I was dead. A lot of people can’t make it through, either, because of depression or their chemistry can’t handle it."

Finally, with help from one of the new drugs released in 2011, Fedorka is now clear of the disease. For years, he has volunteered his time to support and mentor others dealing with the challenge of hepatitis.

At age 60, he is thrilled to think that others may have an easier path.

"It’s just awesome what’s coming up down the road," said Fedorka, a board member of the Hepatitis Support Network. "The future is so promising. They are talking about, in the years 2016 and 2017, there is going to be a single pill that you take."

A report published Wednesday in The Lancet said a daily pill combining sofosbuvir and ledipasvir cleared the virus from 97 of 100 patients infected with the most common strain of hepatitis C, which is tough to treat. Larger trials are underway.

Many people with hepatitis C do not know how they were infected with it. They may have been exposed through unsanitary needles, medical instruments, razor blades, or piercing or tattooing tools, or they may have received contaminated blood before screening began for hepatitis C.

"The whole thing is totally asymptomatic — you don’t know you have it until it’s too late," Fedorka said. He urged people to get a quick, simple blood test so they can take action if necessary.

The world "hepatitis" means inflammation of the liver. Hepatitis A, transmitted through contaminated food or close personal contact, is typically cleared by the body without treatment. Hepatitis B and hepatitis C are blood-borne viruses that can become chronic.

Children in Hawaii are vaccinated against hepatitis B but there is no vaccine for hepatitis C. Hepatitis B is more prevalent in Asia and Pacific Island nations, so Hawaii residents who were born there are advised to be screened for it.

To be tested for hepatitis C, contact your doctor, call 211 or visit www.hepfreehawaii.org for information on where to get tested. For information on the Viral Hepatitis Hawai’i conference, visit www.viralhephi.org.