AASLD (America Association for the Study of Liver Diseases), 50th Annual Meeting, Dallas

African Americans Show High Rate of Genotype 1
Pre-Treatment Differences Between HCV-Infected African Americans and Non-African American Patients

Selected Highlights; Report 3
In the previous NATAP AASLD study report a high percentage of African Americans also had genotype 1. None responded to interferon alone and 20% had sustained virologic response, which is less than expected from general population.

Thomas Layden and others from the University of Illinois at Chicago College of Medicine reported this data. Recent studies have suggested that African American (AA) patients fail to respond to both IFN monotherapy and IFN/Ribavarin combination therapy at a much greater rate than non-AA patients. This data is supported by our ownanecdotal evidence that AA pts. experience early viral clearance at 3 months less than non-AA pts. following Amgen’s consensus interferon (0 vs 39%), Intron A (10 vs 46%), and Rebetron (0 vs 67%). 

To investigate the lack of response of AA pts. To therapy, they analyzed pre-treatment demographic, virological, biochemical and histologic factors in AA vs non-AA HCV-infected treatment-naïve patients (pts.).

AA and non-AA pts enrolled in all HCV-infected treatment-naïve protocols from 1997 to 1999 were retrospectively analyzed in relation to age, gender, duration of HCV infection, alcohol use, risk factors (blood transfusion, IV drug use, tattoo), genotype, baseline ALT and HCV RNA, chirrhosis, and histologic activity of pre-treatment biopsy. 

There were no differences in any of these parameters except Aas did have a greater percentage of genotype 1 HCV than non-Aas (100% vs 73%); p=0.03). AA pts. Had lower mean Knodell Histology Activity Index (HAI) scores than non-AAS (6.2 vs 8,4). The only individual HAI component significantly greater in non-AA pts. Was the piecemeal necrosis (PN) rating (2.7 vs 1.5). Genotype 1 non-AA pts. (n=25) had a greater trend toward both higher HAI (8.3 vs 6.2; p=.06) and PN (2.8 vs 1.5; p=.06).

Layden said these findings confirm that AA pts are more likely to have genotype 1 HCV. Retrospective analysis suggests that the necro-inflammatory hepatic injury is less severe prior to treatment in AA pts., indicating immune recognition of HCV infected hepatocytes in AA pts. Should be examined as a potential factor contributing to the lack of AA response to HCV treatment. AA pts. Since another poster at meeting showed data in small study that AA pts have a good phase 1 viral decline but a flat phase 2 viral decline, this suggests that a genetic or host immunologic difference may be involved. But several researchers here said at this point offering any reason is speculative.