NATAP, DDW Liver Conference, San Diego, May 21-24 - Report 7

Thelma Wiley, MD, from the University of Illinois, Chicago reported in an oral presentation on her findings in a retrospective chart review of African Americans at her hospital .  She is the Medical Director of Liver Transplant at the Digestive Diseases and Liver Center at the UIC Mediucal Center. She found that African Americans progressed more slowly to cirrhosis than caucasians, and less African Americans had cirrhosis than caucasians.  However, its been previously reported that African Americans have a higher rate of liver cancer. She was unable to explain this difference. 

As I've reported before, it's well known that several studies have shown African Americans don't respond well to interferon monotherapy. She offered the same reasons as others have offered--two studies have reported  (96% and 88%, respectively) African Americans are genotype 1, and also  African Americans may lack immune recognition of HCV-infected liver cells. But, this may be true for genotype one's in general. McHutchison has reported that African Americans responded virologically about the same (22%) to other genotype ones in his large US study on IFN+RBV versus IFN monotherapy, but this analysis was based upon only 53 African Americans. However, a second small study reported similar findings. This area needs further research.

There were some limitations in her study as there are with many studies. The study was a restrospective review  (1996-99) of several hundred  African Anerican and caucasian patients charts and biopsies at her hospital. Although  the two groups had a number of similarities including reported alcohol intake,  the African Americans were older (50 vs 46), the AA group had less women, and had longer duration of CHC (26 vs 23 yrs). A number of patients were excluded from the study because of inadequate  information.

Here is Wiley's abstract.

THE NATURAL HISTORY OF HEPATITIS C IN AFRICAN AMERICANS

Background- Hepatitis C (HCV) infects 1-3% of the United States population. African Americans(AA)are disproportionately infected with this virus (5%) and predominately infected with genotype 1 HCV. The natural history of this disease in AA has not been analyzed in a large number of HCV infected patients.

Aim- To analyze demographic, virolgical, biochemical and histological data in order to determine the natural history of liver disease in AA versus non-African Americans (non-AA). Methods We retrospectively reviewed the records of 289 patients with HCV seen at our institution from 1996 through 1999. We included patients who had adequate histological data to assess HAI and the degree of hepatic fibrosis. The following data were collected: age, gender, race, weight, baseline ALT, genotype, HCV RNA levels, mode and duration of infection. The duration of infection was estimated from earliest potential exposure to the virus. Liver biopsies were reviewed (blindly) and graded for histologic activity using the Knodell scoring system (HAI).

Results- There were 93 AA and 196 non-AA patients. There were no significant differences in mean baseline HCV RNA and weight. Although not significant, only 23% of AA's compared to 31% of non-AA's were cirrhotic. There was a significant difference between AA and non-AA patients in piecemeal necrosis (PN)(2.5 vs. 3.1, p=.04), mean baseline ALT(86.55 vs. 112.41, p=.01), age (49 vs. 45, p=.001), and duration of infection(27 vs. 23, p=.002). AA patients were more often infected with genotype 1 HCV (87.7% vs. 70.9%, p=.02) No AA patients were infected with genotype 3 HCV. When analyzing the data according to the duration of infection, AA patients had a lower ALT(56 vs. 134, p=.03), total HAI(3.1 vs. 4.8, p=.05), as well as portal inflammation(1.4 vs. 2.4,p=.02), PN(.8 vs. 3.1, p=.05), and HAI without fibrosis(3.5 vs. 6.6, p=.04) during the second decade of exposure (years 10-19). There were no AA patients with cirrhosis by the second decade compared to 26% of non-AA patients with cirrhosis, although this was not statistically significant. By the third decade (years 20-29), 18% of AA patients vs. 31% of non-AA's were cirrhotic. The degree of fibrosis was significantly greater in non-AA patients (2.1 vs. 2.6, p=.04).

Summary- AA's are more likely to be infected with genotype 1 HCV and tend to progress more slowly to cirrhosis. In addtition, early in their exposure, AA's had lower HAI, baseline ALT, and percentage of cirrhosis, although mean baseline HCV RNA levels and weight were not significantly different.