Skip to main content

Advertisement

SpringerLink
Log in

Ethnic and Racial Differences in the Natural History of Hepatitis C

  • Published:
Current Hepatitis Reports Aims and scope Submit manuscript

Abstract

Hepatitis C virus (HCV) infection is common in the United States and affects all ethnic groups. Important ethnic disparities exist in HCV severity, response to treatment, and progression after liver transplantation. Among patients with chronic HCV, African Americans tend to have less severe disease histologically, whereas Hispanics appear to have a more aggressive disease course compared with non-Hispanic Whites. In contrast, new data suggest that African Americans have more rapid HCV progression after liver transplantation relative to other ethnic groups. African Americans and Hispanics have lower sustained virologic response rates to pegylated interferon and ribavirin compared with non-Hispanic Whites. Awareness of these differences will help clinicians counsel diverse populations of patients on risk of progression, treatment outcome, and expectations after liver transplant. Future investigations of these differences should help in identifying mechanisms behind observed disparities and interventions to improve outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Global surveillance and control of hepatitis C. Report of a WHO consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Hepat 1999, 6:35–47.

  2. Seeff LB, Miller RN, Rabkin CS, et al.: 45-year follow-up of hepatitis C virus infection in healthy young adults. Ann Intern Med 2000, 132:105–111.

    CAS  PubMed  Google Scholar 

  3. Wiese M, Berr F, Lafrenz M, et al.: Low frequency of cirrhosis in a hepatitis C (genotype 1b) single-source outbreak in Germany: A 20-year multicenter study. Hepatology 2000, 32:91–96.

    Article  CAS  PubMed  Google Scholar 

  4. Jackson FL: Race and ethnicity as biological constructs. Ethn Dis 1992, 2:120–125.

    CAS  PubMed  Google Scholar 

  5. Williams DR: Race and health: basic questions, emerging directions. Ann Epidemiol 1997, 7:322–333.

    Article  CAS  PubMed  Google Scholar 

  6. McQuillan GM, Kruszon-Moran D, Kottiri BJ, et al.: Racial and ethnic differences in the seroprevalence of 6 infectious diseases in the United States: data from NHANES III, 1988–1994. Am J Public Health 2004, 94:1952–1958.

    Article  PubMed  Google Scholar 

  7. Crosse K, Umeadi OG, Anania FA, et al.: Racial differences in liver inflammation and fibrosis related to chronic hepatitis C. Clin Gastroenterol Hepatol 2004, 2:463–468.

    Article  PubMed  Google Scholar 

  8. Sugimoto K, Stadanlick J, Ikeda F, et al.: Influence of ethnicity in the outcome of hepatitis C virus infection and cellular immune response. Hepatology 2003, 37:590–599.

    Article  PubMed  Google Scholar 

  9. Nainan OV, Alter MJ, Kruszon-Moran D, et al.: Hepatitis C virus genotypes and viral concentrations in participants of a general population survey in the United States. Gastroenterology 2006, 131:478–484.

    Article  CAS  PubMed  Google Scholar 

  10. Cheng JT, Hsien C, Sun HE, Tong MJ: The emerging importance of chronic hepatitis C infection in Asian Americans. Am J Gastroenterol 2006, 101:2737–2743.

    Article  PubMed  Google Scholar 

  11. Verma S, Bonacini M, Govindarajan S, et al.: More advanced hepatic fibrosis in Hispanics with chronic hepatitis C infection: role of patient demographics, hepatic necroinflammation, and steatosis. Am J Gastroenterol 2006, 101:1817–1823.

    Article  PubMed  Google Scholar 

  12. Bonacini M, Groshen MD, Yu MC, et al.: Chronic hepatitis C in ethnic minority patients evaluated in Los Angeles county. Am J Gastroenterol 2001, 96:2438–2441.

    Article  CAS  PubMed  Google Scholar 

  13. Sterling RK, Stravitz RT, Luketic VA, et al.: A comparison of the spectrum of chronic hepatitis C virus between Caucasians and African Americans. Clin Gastroenterol Hepatol 2004, 2:469–473.

    Article  PubMed  Google Scholar 

  14. • Kallwitz ER, Layden-Almer J, Dhamija M, et al.: Ethnicity and body mass index are associated with hepatitis C presentation and progression. Clin Gastroenterol Hepatol 2009, 2010, 8:72–78. This article presents recent population-based data describing ethnic differences in disease severity with measured metabolic factors.

  15. Fontana RJ, Kleiner DE, Bilonick R, et al.: Modeling hepatic fibrosis in African American and Caucasian American patients with chronic hepatitis C virus infection. Hepatology 2006, 44:925–935.

    Article  CAS  PubMed  Google Scholar 

  16. Cheung RC, Currie S, Shen H, et al.: Chronic hepatitis C in Latinos: natural history, treatment eligibility, acceptance, and outcomes. Am J Gastroenterol 2005, 100:2186–2193.

    Article  PubMed  Google Scholar 

  17. D’Souza R, Glynn MJ, Ushiro-Lumb I, et al.: Prevalence of hepatitis C-related cirrhosis in elderly Asian patients infected in childhood. Clin Gastroenterol Hepatol 2005, 3:910–917.

    Article  PubMed  Google Scholar 

  18. Terrault NA, Im K, Boylan R, et al.: Fibrosis progression in African Americans and Caucasian Americans with chronic hepatitis C. Clin Gastroenterol Hepatol 2008, 6:1403–1411.

    Article  PubMed  Google Scholar 

  19. Poynard T, Bedossa P, Opolon P: Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet 1997, 349:825–832.

    Article  CAS  PubMed  Google Scholar 

  20. Dev A, Patel K, Conrad A, et al.: Relationship of smoking and fibrosis in patients with chronic hepatitis C. Clin Gastroenterol Hepatol 2006, 4:797–801.

    Article  CAS  PubMed  Google Scholar 

  21. Ishida JH, Peters MG, Jin C, et al.: Influence of cannabis use on severity of hepatitis C disease. Clin Gastroenterol Hepatol 2008, 6:69–75.

    Article  PubMed  Google Scholar 

  22. Wiley TE, McCarthy M, Breidi L, et al.: Impact of alcohol on the histological and clinical progression of hepatitis C infection. Hepatology 1998, 28:805–809.

    Article  CAS  PubMed  Google Scholar 

  23. Adinolfi LE, Gambardella M, Andreana A, et al.: Steatosis accelerates the progression of liver damage of chronic hepatitis C patients and correlates with specific hcv genotype and visceral obesity. Hepatology 2001, 33:1358–1364.

    Article  CAS  PubMed  Google Scholar 

  24. Moucari R, Asselah T, Cazals-Hatem D, et al.: Insulin resistance in chronic hepatitis C: association with genotypes 1 and 4, serum HCV RNA level, and liver fibrosis. Gastroenterology 2008, 134:416–423.

    Article  CAS  PubMed  Google Scholar 

  25. Ortiz V, Berenguer M, Rayon JM, et al.: Contribution of obesity to hepatitis C-related fibrosis progression. Am J Gastroenterol 2002, 97:2408–2414.

    Article  PubMed  Google Scholar 

  26. Petta S, Camma C, Di Marco V, et al.: Insulin resistance and diabetes increase fibrosis in the liver of patients with genotype 1 HCV infection. Am J Gastroenterol 2008, 103:1136–1144.

    Article  CAS  PubMed  Google Scholar 

  27. • Vanni E, Abate ML, Gentilcore E, et al.: Sites and mechanisms of insulin resistance in nonobese, nondiabetic patients with chronic hepatitis C. Hepatology 2009, 50:697–706. This study highlights the important relationship between hepatitis C and insulin resistance.

    Article  CAS  PubMed  Google Scholar 

  28. Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among us adults: Findings from the third national health and nutrition examination survey. Jama 2002, 287:356–359.

    Article  PubMed  Google Scholar 

  29. Bedossa P, Moucari R, Chelbi E, et al.: Evidence for a role of nonalcoholic steatohepatitis in hepatitis C: a prospective study. Hepatology 2007, 46:380–387.

    Article  CAS  PubMed  Google Scholar 

  30. Kallwitz ER, Guzman G, Tencate V, et al.: The histologic spectrum of liver disease in African-American, non-Hispanic white, and Hispanic obesity surgery patients. Am J Gastroenterol 2009, 104:64–69.

    Article  PubMed  Google Scholar 

  31. Browning JD, Szczepaniak LS, Dobbins R, et al.: Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004, 40:1387–1395.

    Article  PubMed  Google Scholar 

  32. • Conjeevaram HS, Kleiner DE, Everhart JE, et al.: Race, insulin resistance and hepatic steatosis in chronic hepatitis C. Hepatology 2007, 45:80–87. According to this article, the data show that despite having more risk factors for steatosis, African Americans with HCV have lower expected rates of steatosis.

    Article  CAS  PubMed  Google Scholar 

  33. • Flores YN, Yee HF, Jr., Leng M, et al.: Risk factors for chronic liver disease in blacks, Mexican Americans, and whites in the United States: results from NHANES IV, 1999–2004. Am J Gastroenterol 2008, 103:2231–2238. According to this article, population-based data from NHANES show the rate of risk factors for chronic liver disease in the US population.

    Article  PubMed  Google Scholar 

  34. Muir AJ, Bornstein JD, Killenberg PG: Peginterferon alfa-2b and ribavirin for the treatment of chronic hepatitis C in blacks and non-Hispanic whites. N Engl J Med 2004, 350:2265–2271.

    Article  CAS  PubMed  Google Scholar 

  35. Shiffman ML, Mihas AA, Millwala F, et al.: Treatment of chronic hepatitis C virus in African Americans with genotypes 2 and 3. Am J Gastroenterol 2007, 102:761–766.

    Article  CAS  PubMed  Google Scholar 

  36. • Rodriguez-Torres M, Jeffers LJ, Sheikh MY, et al.: Peginterferon alfa-2a and ribavirin in Latino and non-Latino whites with hepatitis C. N Engl J Med 2009, 360:257–267. Recent study showing a lower rate of response to therapy in Hispanic persons compared to non-Hispanic Whites.

    Article  CAS  PubMed  Google Scholar 

  37. Missiha S, Heathcote J, Arenovich T, Khan K: Impact of Asian race on response to combination therapy with peginterferon alfa-2a and ribavirin in chronic hepatitis C. Am J Gastroenterol 2007, 102:2181–2188.

    Article  CAS  PubMed  Google Scholar 

  38. Rosen HR, Weston SJ, Im K, et al.: Selective decrease in hepatitis C virus-specific immunity among African Americans and outcome of antiviral therapy. Hepatology 2007, 46:350–358.

    Article  CAS  PubMed  Google Scholar 

  39. Layden-Almer JE, Ribeiro RM, Wiley T, et al.: Viral dynamics and response differences in HCV-infected African American and white patients treated with IFN and ribavirin. Hepatology 2003, 37:1343–1350.

    Article  CAS  PubMed  Google Scholar 

  40. He XS, Ji X, Hale MB, et al.: Global transcriptional response to interferon is a determinant of hcv treatment outcome and is modified by race. Hepatology 2006, 44:352–359.

    Article  CAS  PubMed  Google Scholar 

  41. Oleksyk TK, Thio CL, Truelove AL, et al.: Single nucleotide polymorphisms and haplotypes in the il10 region associated with HCV clearance. Genes Immun 2005, 6:347–357.

    Article  CAS  PubMed  Google Scholar 

  42. • Kim KA, Lin W, Tai AW, et al.: Hepatic socs3 expression is strongly associated with non-response to therapy and race in HCV and HCV/HIV infection. J Hepatol 2009, 50:705–711. This article presents recent data highlighting an important mechanism for both insulin resistance and lower response to therapy.

    Article  PubMed  Google Scholar 

  43. Fried MW, Shiffman ML, Reddy KR, et al.: Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002, 347:975–982.

    Article  CAS  PubMed  Google Scholar 

  44. Romero-Gomez M, Del Mar Viloria M, Andrade RJ, et al.: Insulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients. Gastroenterology 2005, 128:636–641.

    Article  CAS  PubMed  Google Scholar 

  45. Backus LI, Boothroyd DB, Phillips BR, Mole LA: Predictors of response of us veterans to treatment for the hepatitis C virus. Hepatology 2007, 46:37–47.

    Article  CAS  PubMed  Google Scholar 

  46. • Moylan CA, Brady CW, Johnson JL, et al.: Disparities in liver transplantation before and after introduction of the MELD score. JAMA 2008, 300:2371–2378. This article shows how the implementation of a standardized means of listing patients for transplant improved an important health disparity.

    Article  CAS  PubMed  Google Scholar 

  47. • Ananthakrishnan AN, Saeian K: Racial differences in liver transplantation outcomes in the meld era. Am J Gastroenterol 2008, 103:901–910. This series highlights important differences in transplant outcome in multiple ethnicities.

    Article  PubMed  Google Scholar 

  48. Velidedeoglu E, Mange KC, Frank A, et al.: Factors differentially correlated with the outcome of liver transplantation in HCV+ and HCV− recipients. Transplantation 2004, 77:1834–1842.

    Article  PubMed  Google Scholar 

  49. Layden JE, Brown KA, Lucey MR, et al.: Hepatitis c virus (HCV) progresses more rapidly after orthotopic liver transplant (OLT) in African Americans (AA) compared to Whites (W). Hepatology 2009, 50:393A.

    Article  Google Scholar 

  50. • Pang PS, Kamal A, Glenn JS: The effect of donor race on the survival of black Americans undergoing liver transplantation for chronic hepatitis C. Liver Transpl 2009, 15:1126–1132. This article presents important new data showing that outcomes in African Americans after transplant might be improved with matching of donor and recipient ethnicity.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflict of interest relevant to this article was reported. There was no writing assistance in the production of this manuscript.

Author information

Authors and Affiliations

  1. Section of Hepatology, University of Illinois, 840 South Wood Street, MC 787, Chicago, IL, 60612, USA

    Eric R. Kallwitz

Authors
  1. Eric R. Kallwitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric R. Kallwitz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kallwitz, E.R. Ethnic and Racial Differences in the Natural History of Hepatitis C. Curr Hepatitis Rep 9, 106–112 (2010). https://doi.org/10.1007/s11901-010-0038-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-010-0038-2

Keywords

Search

Navigation