Current Hepatitis Reports

, Volume 3, Issue 4, pp 129–135

Hepatitis C virus among african-american persons

  • Doris B. Strader


Hepatitis C virus (HCV) is a major cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC). In the United States, approximately 2% of the general population has serum antibodies to HCV. Although African-American persons make up only 12% of the US population, they account for 22% of the estimated 2.7 million persons infected with chronic HCV. In addition, African-American persons with HCV appear to be at greater risk for cirrhosis and HCC, and are less likely to respond to current anti-HCV therapy. Although the explanation for the observed racial differences in HCV prevalence, complications, and response to therapy is unclear, it has been speculated that ethnic variations in viral kinetics, immunogenetics, hepatic steatosis, and hepatic iron concentration may be partly responsible. Unfortunately, limited data are currently available. Adequately powered and sized prospective trials are needed to further investigate these provocative hypotheses.


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References and Recommended Reading

  1. 1.
    Alter MJ, Kruszon-Moran D, Nainan OV, et al.: The prevalence of hepatitis C virus infection in the United States; 1988 through 1994. N Engl J Med 1999, 341:556–562.PubMedCrossRefGoogle Scholar
  2. 2.
    El Serag HB, Mason A: Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 1999, 340:745–750.PubMedCrossRefGoogle Scholar
  3. 3.
    Man RE, Smart RG, Anglin L, Adlaf EM: Reductions in cirrhosis deaths in the United States: associations with per capita consumption an AA memberships. J Stud Alcohol 1991, 52:361–365.Google Scholar
  4. 4.
    Reddy DR, Hoofnagle JH, Tong MJ, et al.: Racial differences in response to therapy with interferon in chronic hepatitis C. Hepatology 1999, 30:787–793.PubMedCrossRefGoogle Scholar
  5. 5.
    Bellantani S, Tiribelli C: The spectrum of liver disease in the general population: lesson from the Dionysos study. J Hepatol 2001, 35:531–537.CrossRefGoogle Scholar
  6. 6.
    Sasaki N, Matsui A, Momoi M, et al.: Loss of circulating hepatitis C virus in children who developed a persistent carrier state after mother-to-baby transmission. Pediatr Res 1997, 42:263–267.PubMedCrossRefGoogle Scholar
  7. 7.
    Vogt M, Lang T, Froesner G, et al.: Prevalence and clinical outcome of hepatitis C infection in children who underwent cardiac surgery before the implementation of blood donor screening. N Engl J Med 1999, 341:866–870.PubMedCrossRefGoogle Scholar
  8. 8.
    Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH: Pathogenesis, natural history, treatment and prevention of hepatitis C. Ann Intern Med 2000, 132;296–305.PubMedGoogle Scholar
  9. 9.
    Alter HJ, Seeff LB: Recovery, persistence, and sequelae in hepatitis C virus infection: a perspective on long-term outcome. Semin Liver Dis 2000, 20:17–35.PubMedCrossRefGoogle Scholar
  10. 10.
    Wiley TE, Mika BP, Mc Carthy ME, Layden TJ: Pre-treatment differences between HCV-infected African American and non-African American patients. Hepatology 1999, 30:417A.Google Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    Di Bisceglie AM, Lyra AC, Schwartz M, et al.: Hepatitis Crelated hepatocellular carcinoma in the United States: influence of ethnic status. Am J Gastreonterol 2003, 98:2060–2063. Hepatitis C virus infection is the major risk factor for HCC among white and African-American persons in the United States. This study failed to find any significant difference in the incidence of HCC among racial groups with HCV.CrossRefGoogle Scholar
  13. 13.
    Manns MP, McHutchison JG, Gordon SC, et al.: Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomized trial. Lancet 2001, 358:958–965.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    Howell C, Jeffers L, Hoofnagle JH: Hepatitis C in African Americans: summary of a workshop. Gastroenterology 2000, 119:1385–1396. Summary of a workshop entitled "Hepatitis C in African Americans" held by the NIH in December 1999. Epidemiology, natural history, complications of HCV, and response to therapy among African-American persons are reviewed and strategies to address health discrepancies are discussed.PubMedCrossRefGoogle Scholar
  16. 16.
    McHutchison JG, Poynard T, Pianko S, et al.: The impact of interferon plus ribavirin on response to therapy in black patients with chronic hepatitis C. Gastroenterology 2000, 119:1317–1323.PubMedCrossRefGoogle Scholar
  17. 17.
    Jeffers LJ, Cassidy W, Howell CD, et al.: Peginterferon alfa-2a (40 kd) and ribavirin for black American patients with chronic HCV genotype 1. Hepatology 2004, 39:1702–1708.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    Sterling RK, Hofmann CM, Luketic VA, et al.: Treatment of chronic hepatitis C virus in the Virginia department of corrections: can compliance overcome racial differences in response? Am J Gastroenterol 2004, 99:866–872.PubMedCrossRefGoogle Scholar
  20. 20.
    Kinzie JL, Naylor PH, Nathani MG, et al.: African Americans with genotype 1 treated with interferon for chronic hepatitis C have a lower end of treatment response than Caucasians. J Viral Hepat 2001, 8:264–269.PubMedCrossRefGoogle Scholar
  21. 21.
    Zeuzem S, Schmidt JM, Lee JH, et al.: Effect of interferon alfa on the dynamics of hepatitis C virus turnover in vivo. Hepatology 1996, 23:366–371.PubMedGoogle Scholar
  22. 22.
    Neumann AU, Lam NP, Dahari H, et al.: Hepatitis C viral dynamics in vivo and the antiviral efficacy of IFN-alfa therapy. Science 1998, 282:103–107.PubMedCrossRefGoogle Scholar
  23. 23.
    Zeuzem S, Hermann E, Lee JH, et al.: Viral kinetics in patients with chronic hepatitis C treated with standard or peginterferon alfa-2a. Gastroenterology 2001, 120:1438–1447.PubMedCrossRefGoogle Scholar
  24. 24.
    Lam NP, Neumann AU, Gretch DR, et al.: Dose-dependent acute clearance of hepatitis C genotype 1 virus with interferon alfa. Heaptology 1997, 26:226–231.CrossRefGoogle Scholar
  25. 25.
    Neumann AU, Lam NP, Dahari H, et al.: Differences in viral dynamics between genotypes 1 and 2 hepatitis C virus. J Infect Dis 2000, 182:28–35.PubMedCrossRefGoogle Scholar
  26. 26.
    Layden-Almer JE, Ribeiro RM, Wiley TE, 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. Extensive discussion of racial differences in phase 1 and phase 2 decline in HCV-RNA levels in response to IFN, and the potential impact of the addition of ribavirin therapy to viral kinetics.PubMedCrossRefGoogle Scholar
  27. 27.
    Gale M Jr, Kwieciszewski B, Dossett M, et al.: Antiapoptotic and oncogenic potentials of hepatitis C virus are linked to interferon resistance by viral repression of the PKR protein kinase. J Virol 1999, 73:6506–6516.PubMedGoogle Scholar
  28. 28.
    Tan SI, Kakao H, He Y, et al.: NS5A, a nonstructural protein of hepatitis C virus binds growth factor receptor-bound protein 2 adaptor protein in a Arc homology 3 domain/liganddependent manner and perturbs mitogenic signaling. Proc Natl Acad Sci U S A 1999, 96:5533–5538.PubMedCrossRefGoogle Scholar
  29. 29.
    Gale M Jr, Katze MG: Molecular mechanisms of interferon resistance mediated by viral-directed inhibition of PKR, the interferon-induced protein kinase. Pharmacol Ther 1998, 78:29–46.PubMedCrossRefGoogle Scholar
  30. 30.
    Enomoto N, Sakuma I, Asahina Y, et al.: Comparison of full-length sequences of interferon-sensitive and resistant hepatitis C virus 1b: sensitivity to interferon is conferred by amino acid substitutions in the NS5A gene. J Clin Invest 1995, 96:224–230.PubMedCrossRefGoogle Scholar
  31. 31.
    Enomoto N, Sakamu Y, Asahina Y, et al.: Mutations in the nonstructural protein 5A and response to interferon in patients with chronic hepatitis C virus 1b infection. N Engl J Med 1996, 334:77–81.PubMedCrossRefGoogle Scholar
  32. 32.
    Chayama K, Tsubota A, Kobayashi M, et al.: Pretreatment virus load and multiple amino acid substitutions in the interferon sensitivity-determining region predict the outcome of interferon treatment in patients with chronic genotype 1b hepatitis C virus infection. Hepatology 1997, 25:745–749.PubMedCrossRefGoogle Scholar
  33. 33.
    Chung RT, Monto A, Dienstag JL, Kaplan LM: Mutations in the NS5A region do not predict interferon responsiveness in American patients infected with genotype 1b hepatitis C virus. J Med Virol 1999, 58:353–358.PubMedCrossRefGoogle Scholar
  34. 34.
    Hofgartner WT, Polyak SJ, Sullivan DG, et al.: Mutations in the NS5A gene of hepatitis C virus in North American patients infected with HCV genotype 1a or 1b. J Med Virol 1997, 53:118–126.PubMedCrossRefGoogle Scholar
  35. 35.
    Pawlotsky JM, Germanidis G, Neumann AU, et al.: Interferon resistance of hepatitis C virus genotype 1b: relationship to nonstructural 5A gene quasispecies mutations. J Virol 1998, 72:2795–2805.PubMedGoogle Scholar
  36. 36.
    Zeuzem S, Lee JH, Roth WK: Mutations in the nonstructural 5A gene of European hepatitis C virus isolates and response to interferon alfa. Hepatology 1997, 25:740–744.PubMedCrossRefGoogle Scholar
  37. 37.
    Schiappa DA, Mittal C, Brown JL, et al.: Role of the interferon sensitivity domain region (ISDR) in IFN non-responsiveness in African-American patients infected with genotype 1 HCV [abstract]. Hepatology 2000, 32:542A.Google Scholar
  38. 38.
    Bain B: Ethnic and sex differences in the total and differential white cell count and platelet count. J Clin Pathol 1996, 49:664–666.PubMedGoogle Scholar
  39. 39.
    Beatty P, Mori M, Milford E: Impact of racial genetic polymorphism on the probability of finding an HLA-matched donor. Transplantation 1995, 60:778–783.PubMedCrossRefGoogle Scholar
  40. 40.
    Kerman R, Kimball P, Kahan B: Stronger immune responsiveness of blacks versus whites may account for renal allograft survival differences. Transplant Proc 1991, 23:400–402.PubMedGoogle Scholar
  41. 41.
    Park M, Tolman D, Kimball P: The impact of race and HLA matching on long term survival following cardiac transplantation. Transplant Proc 1997, 29:1460–1463.PubMedCrossRefGoogle Scholar
  42. 42.
    Vasquez E, Benedetti E, Pollak R: Late acute rejection is more prevalent among African American renal allograft recipients and is frequently associated with allograft loss. Transplant Proc 1998, 30:1173–1175.PubMedCrossRefGoogle Scholar
  43. 43.
    Kimball P, Elswick RK, Shiffman M: Ethnicity and cytokine production gauge response of patients with hepatitis C to interferon-alfa therapy. J Med Virol 2001, 65:510–516.PubMedCrossRefGoogle Scholar
  44. 44.
    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.PubMedCrossRefGoogle Scholar
  45. 45.
    Hwang SJ, Luo JC, Chu CW, et al.: Hepatic steatosis in chronic hepatitis C virus infection: Prevalence and clinical correlation. J Gastroenterol Hepatol 2001, 16:190–195.PubMedCrossRefGoogle Scholar
  46. 46.
    Giannini E, Ceppa P, Botta F, et al.: Steatosis and bile duct damage in chronic hepatitis C: distribution and relationship in a group of northern Italian patients. Liver 1999, 19:432–437.PubMedCrossRefGoogle Scholar
  47. 47.
    Hourigan LF, Macdonald GA, Purdie D, et al.: Fibrosis in chronic hepatitis C correlates significantly with body mass index and steatosis. Hepatology 1999, 29:1215–1219.PubMedCrossRefGoogle Scholar
  48. 48.
    Fujie H, Yotsuyangi H, Moriya K, et al.: Steatosis and intrahepatic hepatitis C virus in chronic hepatitis. J Med Virol 1999, 59:141–145.PubMedCrossRefGoogle Scholar
  49. 49.
    Lam NP, Pitrak D, Speralakis R, et al.: Effect of obesity on pharmacokinetics and biologic effect of interferon-alfa in hepatitis C. Dig Dis Sci 1997, 42:178–185.PubMedCrossRefGoogle Scholar
  50. 50.
    Bressler BL, Guindi M, Tomlinson G, Heathcote J: High body mass index is an independent risk factor for nonresponse to antiviral treatment in chronic hepatitis C. Hepatology 2003, 38:639–644.PubMedCrossRefGoogle Scholar
  51. 51.
    Walsh MJ, Vanags DM, Clouston AD, et al.: Steatosis and liver cell apoptosis in chronic hepatitis C: a mechanism for increased liver injury. Hepatology 2004, 39:1230–1238.PubMedCrossRefGoogle Scholar
  52. 52.
    Mehta SH, Brancati FL, Strathdee SA, et al.: Hepatitis C virus infection and incident type 2 diabetes. Hepatology 2003, 38:50–56.PubMedCrossRefGoogle Scholar
  53. 53.
    Mason AL, Lau JYN, Hoang N, et al.: Association of diabetes mellitus and chronic hepatitis C virus infection. Hepatology 1999, 2:328–333.CrossRefGoogle Scholar
  54. 54.
    Simo R, Hernandez C, Genesca J, et al.: High prevalence of hepatitis C virus infection in diabetic patients. Diabetes Care 1996;9:998–1000.CrossRefGoogle Scholar
  55. 55.
    Shintani Y, Fujie H, Miyoshi H, et al.: Hepatitis C virus infection and diabetes; direct involvement of the virus in the development of insulin resistance. Gastroenterology 2004, 126:917–919.CrossRefGoogle Scholar
  56. 56.
    Romero-Gomez M, Castellano-Megias V, Grande L, et al.: Serum leptin levels correlate with hepatic steatosis in chronic hepatitis C. Am J Gastroenterol 2003, 98:1135–1141.PubMedGoogle Scholar
  57. 57.
    Sharma P, Balan V, Hernandez J, et al.: Hepatic steatosis in hepatitis C virus genotype 3 infection: does it correlate with body mass index, fibrosis and HCV risk factors? Dig Dis Sci 2004, 49:25–29.PubMedCrossRefGoogle Scholar
  58. 58.
    Hall WD, Clark LT, Wenger NK, et al.: The metabolic syndrome in African Americans: a review. Ethn Dis 2003, 13:414–418.PubMedGoogle Scholar
  59. 59.
    Dekkers JC, Podolsky RH, Treiber FA, et al.: Development of general and central obesity from childhood into early adulthood in African American and European American males and females with a family history of cardiovascular disease. Am J Clin Nutr 2004, 79:661–668.PubMedGoogle Scholar
  60. 60.
    Ioannou GN, Dominitz JA, Weiss NS, et al.: Racial differences in the relationship between hepatitis C infection and iron stores. Hepatology 2003, 37:795–801.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • Doris B. Strader
    • 1
  1. 1.Department of Gastroenterology/HepatologyFletcher Allen Health Care, University of Vermont, College of MedicineBurlingtonUSA

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