Autoimmune hepatitis in African Americans: presenting features and response to therapy

Lim, Kie N.; Casanova, R; Boyer, Thomas D.; Bruno, Christine J.

doi:10.1111/j.1572-0241.2001.05272.x

Cited by 98 publications

(68 citation statements)

References 18 publications

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“…Cirrhosis is present at accession more commonly in black North American patients with autoimmune hepatitis than in white North American patients (85% vs. 38%, respectively), and they are younger at presentation than their white counterparts. 14 These findings suggest that black North Americans have a more aggressive disease than white North Americans and that their higher frequency of advanced disease reflects intrinsic disease behavior rather than delays in diagnosis or difficulties in accessing medical care. These implications must be clarified by larger cohort studies that assess racial, genetic, and socioeconomic variables.…”

Section: Racial Regional and Genetic Effectsmentioning

confidence: 78%

Treatment challenges and investigational opportunities in autoimmune hepatitis

et al. 2005

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New drugs and advances in molecular biology afford opportunities to upgrade the treatment of autoimmune hepatitis. The aims of this study were to define treatment problems, identify possible solutions, and stimulate investigations to improve patient care. A clinical subcommittee of the International Autoimmune Hepatitis Group reviewed current management difficulties and proposed corrective actions. The assessment of new front-line and salvage therapies for adults and children were given top priority. Cyclosporine and mycophenolate mofetil were endorsed as drugs worthy of rigorous study in severe disease, and budesonide was endorsed for study as front-line therapy in mild disease. Diagnostic criteria and treatment regimens for children required codification, and pharmacokinetic studies were encouraged to develop optimal dosing schedules based on therapeutic ranges. Collaborative efforts were proposed to help understand racial, geographical, and genetic factors affecting outcome and to establish definitions and therapies for variant syndromes and graft dysfunction after transplantation. The development of experimental animal models was deemed essential for the study of site-specific molecular interventions, and gene therapy was endorsed as a means of bolstering reparative processes. In conclusion, evolving pharmacological and technical advances promise to improve the treatment of autoimmune hepatitis, and investigations of these advances are timely, feasible, and necessary. (HEPATOLOGY 2005;41:207-215.)

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Section: Racial Regional and Genetic Effectsmentioning

confidence: 78%

Treatment challenges and investigational opportunities in autoimmune hepatitis

et al. 2005

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“…In another study, the dosage of prednisone required at 3 months following initiation of therapy was higher in African Americans than whites, despite similar rates of concomitant immunosuppression with azathioprine. 26 The amount of steroids required to maintain AIH in remission during follow-up was also 3-fold higher in African Americans than whites. At 12 months followup, there was a nonsignificant trend for African Americans to more likely be on azathioprine (74%) compared to whites (48%).…”

Section: Racial Disparities In the Treatment Of Liver Diseasementioning

confidence: 97%

“…Lim et al showed in a single-center retrospective study of 51 patients with AIH showed that African Americans were more than twice as likely to initially present with cirrhosis (85%) compared to whites (38%). 26 Average prothrombin time was also more prolonged among African Americans than whites (16.4 seconds versus 13.5 seconds). In a larger single-center study of 101 patients with AIH, African Americans were more likely than whites to initially present with liver failure (37.8% versus 9.3%, P ϭ 0.001) and more likely to require referral for transplantation (24.3% versus 6.2%, P ϭ 0.009).…”

Section: Racial Variations In Disease Presentationmentioning

confidence: 99%

Racial disparity in liver disease: Biological, cultural, or socioeconomic factors

Nguyen¹,

Thuluvath²

2008

Hepatology

149

136

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Chronic liver diseases are a major public health issue in the United States, and there are substantial racial disparities in liver cirrhosis-related mortality. Hepatitis C virus (HCV) is the most significant contributing factor in the development of chronic liver disease, complications such as hepatocellular carcinoma, and the need for liver transplantation. In the United States, African Americans have twice the prevalence of HCV seropositivity and develop hepatocellular carcinoma at more than twice the rate as whites. African Americans are, however, less likely to respond to interferon therapy for HCV than are whites and have considerably lower likelihood of receiving liver transplantation, the only definitive therapy for end-stage liver disease. Even among those who undergo transplantation, African Americans have lower 2-year and 5-year graft and patient survival compared to whites. We will review these racial disparities in chronic liver diseases and discuss potential biological, socioeconomic, and cultural contributions. An understanding of their underlying mechanisms is an essential step in implementing measures to mollify racially based inequities in the burden and management of liver disease in an increasingly racially and ethnically diverse population. (HEPATOLOGY 2008;47:1058-1066

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“…Certain non-white groups of patients including African-American, South American, African and Asian were observed to be younger than their white counterparts at presentation. However in one relatively large multiethnic cohort which included Whites, Hispanics and Asians age at diagnosis was similar among all groups [7,8,15,17,19,35]. The reported female predominance in AIH also was observed as female out-numbered male patients almost 4 folds [7,8,10,17,25,35].…”

Section: Discussionmentioning

confidence: 91%