Effect of Treatment for CHC on Liver Disease Progression and Hepatocellular Carcinoma Development in African Americans

Abstract

Background and Aims: African Americans (AA) historically have a low response rate to hepatitis C therapies, and there is limited information available for this patient population regarding the development and treatment of chronic hepatitis C (CHC). The aim of this study was to evaluate liver disease progression and hepatocellular carcinoma (HCC) development in AA with CHC. Methods: Between 1995 and 2008, 246 AA patients with CHC were identified from a database of patients and followed until 2012-2013 (average 8 years) or the development of HCC after 2008. Results: Viral clearance (intent to treat; sustained virus response (SVR)) was achieved in 15% of patients with interferon based therapies with or without ribavirin. AA patients who achieved an SVR (n=22) did not develop HCC or new onset cirrhosis, whereas the HCC incidence in untreated AA patients was 23% (51/203). Patients who achieved an SVR also had improved fibrosis, as defined by the AST Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) score, relative to nonresponders and untreated patients. Conclusions: The severity of liver disease at the first visit (except for cirrhosis) correlated with the development of HCC, but because of the overlap in values between patients, these measurements were not useful for predicting individual risk. Since cirrhosis at the first visit was not a predictive factor, treatment with newer antiviral therapies is the best option for reducing the incidence of advanced liver disease and its harmful outcomes in the AA population.

Real World Response to Direct Acting Antivirals DAA in African Americans Treated in a Non-Gastroenterology Setting

“…African Americans (AA) who are more likely to be infected with hepatitis C than Caucasians, comprise 23% of infected population, are more likely to develop hepatocellular carcinoma than non-AA populations in the United States, and are more likely to be infected with hepatitis C genotype [5][6][7][8][9][10] . Ribavirin/Interferon based regimens were less effective in the African American population which helped to contribute to the increased numbers of AA patients with CHC [11][12][13][14][15][16] . The utilization of dual direct acting antiviral agent (DAA) combinations such as sofosbuvir/ledipasvir (Harvoni®) has provided a shift into an oral, tolerable and effective regimen with fixed dosing and treatment period [17] .…”