Study Suggests Hispanics Progress More Quickly than Blacks & Whites

THE HISTOPATHOLOGICAL IMPACT OF RACE IN VETERANS WITH HCV INFECTION: ALT predicts histologic activity; both white blood cell count & alkaline phosphatase predicted fibrosis

This research group from the University of Miami compared HCV progression for whites, blacks & hispanics. They looked at 246 veterans from  the Miami VA Medical Center. But complete data was available in only 96 patients. Dr Schiff was involved in this study and is a very well respected researcher in this field. They looked at histologic activity and fibrosis stage. They also looked at ALT. They found that histlogic activity was statistically significantly higher in hispanics than blacks or whites (p=0.001). They found that fibrosis stage was more advanced in hispanics than blacks (p=0.01) and whites (p=0.08). The numbers in parenthesis mean the differences were found to be statistically significant which is important to researchers. If differences are not statistically significant, the results may not be reliable. The researchers also found that ALT predicted histologic activity and this also was statistically significant (p=0.036). Also important, researchers found alkaline phosphatase (measure of liver function) & white blood cell count to be statistically significant predictors of fibrosis.

Prevalence. The authors also reported a 38% coinfection rate at the VA but said they may have ubderestimated the incidence because they said thorough chart review was not available. Illegal drug use was isentified as the overall primary risk factor for HCV/HIV coinfection (63%) compared with sexual risk factors (34%). They reported that in the HIV veteran group 528 patients (38%) were HCV antibody positive, and 61% were black, 23% white, 13$ hispanic and 3% unknown. The authors concluded risk factors were similar for black & hispanic vets. But, sexual risk factors were more predominant among white HCV/HIV vets. The author's conclusions suggest that they believe sexual behavior may have contributed to HCV transmission in this group of individuals. Among 325 black vets with HCV/HIV, 63% used illegal drugs, 18% were heterosexual, 7% engaged in homosexual or bisexual activites, 17% had multiple risk factors and 6% were unknown. In 121 white vets, 46% used illegal drugs, 30% were homosexual or bisexual, 8% were heterosexual, 8% had multiple risk factors, and 7% were unknown. They also said survival was similar across race: 54% blacks survived, 54% whites, and 52% hispanics.

The authors concluded that alcohol intake (which is bad for HCV progression) and other risk factors may have cause the differences in progression seen in this study, but they believe that race may have an impact on both histological activity and fibrosis progression of the liver. But, the authors concluded that further well designed studies are required to more definitively understand the effect of race on liver histology or in other words if hispanics do in fact progress more quickly. So, they are not certain of their findings.

(Damien B Mallat, Larry Young, Univ of Miami, Miami, FL; Claire Milikowski, Lennox Jeffers, Miami VA Medical Ctr, Miami, FL; Eugene R Schiff, Univ of Miami, Miami, FL)

Background: The natural history and prognostic factors in patients with HCV are still evolving. Host factors are considered important determinants of fibrosis in patients infected with HCV. Aims: To study the correlation of ethnic background with the histopathology of the liver and to evaluate predictor variables for hepatic histological severity in patients with HCV infection. Setting: The Miami VA Medical Center has strong diversity of patients from different racial groups.

Design: A retrospective analysis of 246 veterans from the Miami VA Medical Center who underwent liver biopsy for HCV infection between 1995 and 2000 were included. Complete data on race was available only in 96 patients. One single pathologist re-evaluated all coded liver biopsies using the Batts-Ludwig histologic score. Both basic descriptive and regression analysis were applied.

Results: Of the 96 patients studied, all but one were male. Fifty-four patients (56%) were white, 23 patients (23%) were black, and 19 patients (18%) were hispanic. The average age was not significantly different among white, black and hispanic patients (49 years, 48 years, and 43 years respectively). The mean histological activity was 2.16 among whites, 2.04 among blacks, and 2.63 among hispanics. Histological activity was significantly higher in hispanic patients than black or white patients ( P=0.001). In addition, the mean fibrosis stage was 2.10 in whites, 1.90 in blacks, and 2.47 in hispanics. Fibrosis stage was more advanced in hispanics than blacks (P=0.01), or whites (P=0.08). White patients were found to have a higher stage than black patients (P=0.18), although statistically non-significant. Steatosis on liver biopsy was similar among all racial groups. Using Pearson correlation, the inter-observer effect of Batts-Ludwig score was approximately 0.75. Finally, univariate regression analysis showed ALT to be the only statistically significant predictor of histological activity (P=0.036), however both white blood cell count and alkaline phosphatase were statistically significant predictors of the fibrosis stage.

 Table of Data

P1 for Hispanics and Whites, P2 for Hispanics and Whites; P3 for Blacks and Whites