Treatment Options for Hepatitis C and the Rationale for Low Response Rates in African Americans

Abstract

Hepatitis C virus (HCV), the leading cause for liver transplantation, is emerging as1 of the infections that pose public health problems in the world since about 170 million people worldwide are infected with this virus. Inequality in addressing racial/ethnic disparities in treatment for hepatitis C is a pressing problem. HCV is more common among African Americans than among other racial groups in the United States. Although African Americans have been shown to have a lower rate of viral clearance and a higher rate of chronic hepatitis C, they may have at the same time a much lower rate of fibrosis progression compared to Caucasians. The purpose of this study is to summarize treatment options available for hepatitis C in African Americans and to describe the different mechanisms thought to be the reasons for the disparate response to treatment in African Americans.

Type III Interferons in Hepatitis C Virus Infection

“…Factors associated with higher odds of spontaneous resolution or response to IFN therapy include virus genotype, gender, and ethnicity, suggesting that genetic factors are key determinants of viral clearance (14, 15). Individuals of European ethnicities were more likely to achieve SVR compared to individuals of African ancestry (14, 16). These differences accompanied by the difficulties and side effects associated with IFN treatment prompted research into genetic factors that can predict SVR.…”

The pharmacokinetics of peginterferon alfa‐2a and ribavirin in African American, Hispanic and Caucasian patients with chronic hepatitis C

“…[10][11][12][13] Efficacy of this therapy is variable, with response dependent largely on viral genotype and race. [14][15][16] Patients infected with genotype 1 CHC have lower SVR rates compared with those with genotypes 2 and 3. 14,17,18 SVR is 52% for genotype 1 CHC patients, while genotype 2 or 3 patients have an SVR rate of 70-80%.…”

“…This combination produces sustained virological response (SVR) rates of up to 66% in randomised multinational trials . Efficacy of this therapy is variable, with response dependent largely on viral genotype and race . Patients infected with genotype 1 CHC have lower SVR rates compared with those with genotypes 2 and 3 .…”