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Hispanics Developed Cirrhosis More Quickly Due to the presence of Fatty Liver & Diabetes
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Reported by Jules Levin
http://www.natap.org
from AASLD
Nov 11, 2005, San Francisco
"GREATER PREVALENCE OF CIRRHOSIS IN HISPANICS THAN IN CAUCASIANS OR AFRICAN AMERICANS"
Conclusion: 1) Cirrhosis was 2.5 times more common in Hispanics than in Caucasians and 4 times more than in African Americans with hepatitis C. 2) This greater prevalence of cirrhosis among Hispanics was associated with increased incidence of steatosis and diabetes, and with higher serum Fe and Fe saturation.
Anastacio Hoyumpa, Francis E. Sharkey, Paul S. Brock, Robert T. Page, Paul S. Brock, Maryam R. Kashi, University of Texas Health Science Center, San Antonio, TX; Ana M. Herrera, University Physicians Group, San Antonio, TX; William Smith, Isela G. Poy, Amy L. Webb, University of Texas Health Science Center, San Antonio, TX; Olga Ali, South Texas Veterans Health Care System,
Audie Murphy Division, San Antonio, TX
There are racial differences in epidemiology, histology and treatment response of patients with hepatitis C. The present study focuses on the Hispanic patients.
Aim: To determine the prevalence of cirrhosis in Hispanics, Caucasians and African Americans with hepatitis C.
Methods: Pretreatment liver biopsies of hepatitis C patients seen between 2000 and 2004 were reviewed (those with less than 4 portal tracts were excluded). Biopsies were assessed by a single pathologist for inflammation, fibrosis, fatty change, iron deposits and were correlated with clinical parameters, including
age, sex, race, diabetes, BMI, genotype, viral load, lipids, alcohol, Fe levels and co-morbidities. There were 222 patients with single biopsies.
Results:
Cirrhosis (grade 4 fibrosis) was found in 30.2% of 144 Hispanics, 12.1% of 62 Caucasians (p 0.007) and 7.1% of 16 African Americans (p 0.05).
Grades of inflammation were: Hispanics: 1.28 ± 0.4, Caucasian: 1.15 ± 0.4 (p 0.05) and African Americans: 1.25 ± 0.04 (p 0.05).
Stages of fibrosis were Hispanics: 2.4 ± 1.2, Caucasians: 1.7 ± 1.1 (p=0.01) and African Americans: 1.7 ± 1.1 (p=0.06). These differences were associated with an increased incidence of steatosis in Hispanics (70.8%) compared to 45.2% in Caucasians (p <.001) and 37.5% in African Americans (p=0.007).
Diabetes mellitus was also more common in Hispanics (28.9%) than in Caucasians (10.2%, p=0.003), but different in African Americans (40.0%, p 0.38).
Serum Fe level was higher in Hispanics, 118.2 ± 52 g/dl than in Caucasians, 102.8 ± 43 (p =0.05), as was Fe saturation, 36.2 ± 18% vs 30.5 ± 14%, respectfully (p =0.03). Data were insufficient for African Americans.
Ferritin levels were similar in Hispanics and Caucasians.
No statistical differences were noted in all three groups with respect to age, sex
distribution, cholesterol, genotype I distribution, IV drug use and co-infection with HIV or HBV.
Conclusion: 1) Cirrhosis was 2.5 times more common in Hispanics than in Caucasians and 4 times more than in African Americans with hepatitis C. 2) This greater prevalence of cirrhosis among Hispanics was associated with increased
incidence of steatosis and diabetes, and with higher serum Fe and Fe saturation.
"HISPANIC RACE/ETHNICITY IS ASSOCIATED WITH AN AGGRESSIVE COURSE OF CHRONIC HEPATITIS C INFECTION: ROLE OF PATIENT DEMOGRAPHICS, HEPATIC STEATOSIS AND NECROINFLAMMATION "
Conclusion: Hispanics have an aggressive course of HCV infection compared to NHW. This is related to older age at exposure, higher necroinflammatory scores and prevalence of hepatic steatosis. Race/ethnicity is an important variable that should be weighed in when deciding treatment options for patients with HCV infection.
Sumita Verma, University of Southern California, Los Angeles, CA; Maurizio
Bonacini, California pacific Medical Center, San Francisco, CA; Sugantha Govindarajan, Rancho Los Amigos Center, Downey, CA; Gary Kanel, Karen Lindsay, University of Southern California, Los Angeles, CA; Allan Redeker, Rancho Los Amigos MEdical Center, Downey, CA
Background and Aims: There is very little data available on patient demographics and liver histology in Hispanic patients with chronic hepatitis C (HCV) infection. The aim of this study was to analyze the severity of HCV related liver disease amongst the Hispanics compared to other race/ethnic groups.
Patients and Methods: patients were recruited from the Los Angeles County Hepatitis Clinic. Race/ethnicity was classified as: Non Hispanic Whites (NHW), Hispanics and Others (Blacks and Asians). Liver fibrosis and necroinflammatory score were assessed by the Ishak scoring system. Hepatic steatosis was graded as 0-4.
Results:
296 patients were found suitable for the study (NHW 63, Hispanic 169 and Others 64). Hispanics were older at exposure due to higher prevalence of blood transfusion as a risk factor (p 0.007 vs NHW).
They also had significantly higher fibrosis stage (3.3 ± 2 vs 2.3 ± 6.9, p=0.001), necroinflammatory score (6.4 ± 1.8 vs 5.6 ± 1.6, P=0.002) and faster fibrosis progression (0.14 ± 0.09/yr vs 0.09 ± 0.07/yr), (p=0.0002 vs NHW).
Prevalence of obesity (52%) and hepatic steatosis (77%) was highest in Hispanics vs NHW (22% and 47%) and Others (31% and 47%), p<0.004. Mean steatosis grade (1.1 vs 0.6) was also higher in Hispanics vs NHW and Others, p <0.0003.
Non-NHW ethnicity, OR 1.8 (95% CI 1.0-3.5), P=0.08, and necroinflammatory score, OR 1.6 (95% CI 1.3-1.8), P<0.0001 were independent predictors of fibrosis stage ≥4.
Hispanic ethnicity was an independent predictor of both NI score ≥7 (OR 1.7 (95% CI 1.0-2.8), p 0.05) and hepatic steatosis (OR 3.0 (95% CI 1.6-5.6), p 0.0007.
A significant correlation was observed between fibrosis stage and both NI score (r=0.45, p<0.001) and hepatic steatosis (r=0.21, p=0.001).
Conclusion: Hispanics have an aggressive course of HCV infection compared to NHW. This is related to older age at exposure, higher necroinflammatory scores
and prevalence of hepatic steatosis. Race/ethnicity is an important variable that should be weighed in when deciding treatment options for patients with HCV infection.
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