Ken Akinaka found out he had hepatitis C when he went in for a physical 10 years ago.

Hep C a ‘silent epidemic’

Only 6,000 of 20,000 infected
in Hawaii know that they are

Ken Akinaka was lucky.

He learned during an annual physical exam in 1993 that he was infected with hepatitis C.

An estimated 20,000 residents may have the virus, but only about 6,000 know it, said Akinaka, co-founder of the Hepatitis Prevention, Education Treatment and Support Network.

"They usually don't feel any symptoms until they have end-stage liver disease," he said, pointing out the virus usually is not picked up in a regular physical exam.

"If you don't look for it, you cannot find it," said Dr. Naoky Tsai, medical director of St. Francis Medical Center's Liver Center and professor at the University of Hawaii John A. Burns Medical School.

For example, he said 1 percent of supposedly healthy people giving blood in the huge national drive after the Sept. 11, 2001, terrorist attacks tested positive for hepatitis C.

Tsai believes publicity about the disease and prominent people affected, such as rock entertainer John Rush and "Baywatch" star Pamela Anderson, has increased awareness in recent years.

He said more people are asking for liver tests, and "we actually have, I would call, a 'cure,'" with combined drugs, pegylated interferon and Ribavirin.

The current interferon is the same as that used three or four years ago, but it is secreted more slowly and is longer-acting, so a patient only needs to inject it once a week instead of every other day, Tsai said. Ribavirin is taken orally, two pills a day, he said.

"Some people may not say it's a real cure, but up to 50 percent of hepatitis C patients across the board, no matter what genotype they have, have achieved eradication of the virus," Tsai said.

"Also, even after the treatment stopped, the virus did not come back, and the liver disease stopped progressing. Many actually returned to normal."

Akinaka, 56, said he had used injection drugs in the 1960s, and his liver enzymes were elevated in the 1993 exam. He had been on medications previously but started the state-of-the-art drug therapy May 2.

"My virus is undetectable at 2 1/2 months," he said. "I'm real hopeful in the next 2 1/2 months, if all goes well I might be cured." He won't know for sure for about two years, he said.

Tsai, a consultant for the hepatitis network, said he has followed many patients more than six years, and nearly all of them remained virus-free.

"In my book, I think this is a 'cure,' although many virologists would tell you once infected, you never get rid of the virus."

No vaccine is available for hepatitis C, which affects about 4 million people in the United States, according to the national Centers for Disease Control and Prevention.

It is a more common blood-borne infection than HIV, said Akinaka, clinical research coordinator at the nonprofit Drug Addiction Services of Hawaii Inc.

Akinaka said the greatest concerns in the hepatitis C "silent epidemic" are people infected 10 to 20 years ago who are not aware of it and now have liver disease. Most people dying are between 40 and 54 years old, he said.

About 80 percent of those infected have no symptoms, but these signs may occur: jaundice, fatigue, dark urine, abdominal pain, loss of appetite and nausea. Fatigue is probably the first noticeable symptom, said Akinaka.

The virus is not spread by casual contact, he stressed, but by contact with the blood of an infected person.

At risk are people who received blood from a donor who later tested positive for the virus, those who injected illegal drugs many years ago, even a few times, or received a blood transfusion or organ transplant before July 1992 in the United States or at any time in a Pacific Rim country that does not screen for hepatitis C.

Others at risk are those who have been on long-term kidney dialysis, have evidence of liver disease or received clotting factors derived from plasma before 1987 to treat hemophiliacs.

Tsai said the CDC pointed to tattooing as a method of transmission a few years ago but downplayed it after finding many people with tattoos were injecting drugs.

"However, I do caution people, if they're going to do tattooing, to make sure the needle is clean and the ink is not shared with other people," he said.

Anyone in a risk category is urged to ask a doctor for a blood test or test themselves with a kit available for $49.95 from Home Access Health Corp. at

Karla Hayes, state hepatitis prevention coordinator, said she is working with other state and contract agencies to integrate hepatitis C prevention into other prevention programs.

She is also in the beginning phases of looking at hepatitis C testing for high-risk adults, she said.

Akinaka was part of a group in San Francisco that created a Hepatitis C International Global Conference held from 1997 to 2001.

He was a co-founder of the Hepatitis C Global Foundation Inc. and is active in many organizations, including the National Hepatitis C Advocacy Council. He was part of a council effort to draft legislation pending in Congress to provide $90 million for hepatitis C testing and education.

The Hawaii network pushed for a resolution in the last legislative session asking the state Health Department to develop public health strategies to address the hepatitis C problem.

Akinaka said he became a hepatitis C advocate to save his life, as well as those of other people.

"It is a preventable disease for many people, and we're letting people die. If we wait longer, it will cost the health care system more than if we try to do adequate testing and treatment now."

The HepCats, a hepatitis C support group, meets at 6:30 p.m. the fourth Tuesday of every month at the Life Foundation in the old Gold Bond building.

Information is available by calling the 2-1-1 Hotline in Hawaii or the Hep C Connection, 800-522-HEPC, located in Denver.


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