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Chronic hepatitis C treatment patterns in African American patients: an update
1Department of Medicine, Mount Sinai School of Medicine; and North General Hospital, New York, New York, USA.
Insights
African Americans experience higher rates of chronic hepatitis C virus (HCV) infection and complications. Combination therapy with pegylated interferons and ribavirin is recommended for all patients, despite lower response rates in African Americans.
Area of Science:
- Hepatology
- Infectious Diseases
- Gastroenterology
Background:
- Significant racial disparities exist in chronic hepatitis C virus (HCV) infection incidence and outcomes in the US.
- African Americans exhibit higher HCV prevalence, particularly genotype 1, and increased risk of complications like hepatocellular carcinoma.
- Current combination therapy (pegylated interferons and ribavirin) shows improved sustained virologic response (SVR) but lower efficacy in African Americans compared to other groups.
Purpose of the Study:
- To summarize the current understanding of racial disparities in HCV infection and treatment response.
- To highlight the efficacy and tolerability of combination therapy with pegylated interferons and ribavirin.
- To recommend treatment strategies for chronic HCV infection across diverse ethnic and racial groups.
Main Methods:
- Review of existing literature on HCV racial disparities and treatment outcomes.
- Analysis of a recent clinical trial involving peginterferon alpha-2a plus ribavirin in African American patients.
- Discussion of ongoing research into genetic factors influencing HCV incidence and treatment response.
Main Results:
- A recent trial demonstrated a 26% SVR rate in African American patients treated with peginterferon alpha-2a plus ribavirin, an improvement over previous findings.
- 90% of participants in the trial showed stabilization or improvement in liver fibrosis.
- No definitive host or viral genetic factors have been identified to explain observed racial disparities.
Conclusions:
- Combination therapy with pegylated interferons and ribavirin offers improved SVR rates and tolerability for chronic HCV infection.
- Despite lower response rates in African Americans, this combination therapy is recommended for all patients due to its overall benefits.
- Further research is needed to elucidate the genetic basis of racial disparities in HCV and optimize treatment strategies.
Abstract:
There are large racial disparities in the incidence of chronic hepatitis C virus (HCV) infection in the United States. The prevalence of HCV, and the prevalence of infection with HCV genotype 1, is higher among African Americans than among other ethnic groups. African Americans also have a higher incidence of complications of HCV infection, including a higher incidence of antibodies to HCV RNA and higher incidences of occurrence of and mortality from hepatocellular carcinoma. Combination therapy with pegylated interferons and ribavirin has increased the sustained virologic response (SVR) rates, and decreased the rates and severity of adverse events, over those observed with standard interferons, with or without ribavirin, although SVR rates with peginterferons plus ribavirin are lower in African Americans than in other ethnic groups. A recent clinical trial of peginterferon alpha-2a plus ribavirin in African American patients resulted in a higher SVR rate, 26%, than observed previously, and 90% of patients showed stabilization or improvement in fibrosis. No host or viral genetic differences have yet been identified to explain the racial disparities in incidence of HCV or response to treatment, but clinical trials are currently ongoing to identify these factors. Because treatment with pegylated interferons plus ribavirin yields improved SVR rates with good tolerability, while the basis for lower response rates in African Americans is not yet known, it is recommended that all patients with chronic HCV infection, regardless of ethnic or racial background, receive combination therapy.
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