Fibrosis Progression in African Americans and Caucasian Americans With Chronic Hepatitis C

• Published in: Clinical gastroenterology and hepatology Vol. 6; no. 12; pp. 1403 - 1411
• Main Authors: Terrault, Norah A, Im, Kelly, Boylan, Ross, Bacchetti, Peter, Kleiner, David E, Fontana, Robert J, Hoofnagle, Jay H, Belle, Steven H
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2008
• Subjects: Adult; African Americans; Cohort Studies; Disease Progression; European Continental Ancestry Group; Female; Gastroenterology and Hepatology; Hepatitis C, Chronic - pathology; Humans; Liver Cirrhosis - pathology; Male; Middle Aged; Models, Statistical; Risk Factors; Severity of Illness Index; United States; United States; AA; CI; Virahep-C; HR; IQR; interquartile range; Viral Resistance to Antiviral Therapy of Chronic Hepatitis C; Caucasian American; HIV; human immunodeficiency virus; hazard ratio; confidence interval; CA; African American
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2008.08.006

Background & Aims Prior studies suggest the rate of liver fibrosis progression is slower in African Americans (AAs) than Caucasian Americans (CAs) with chronic HCV infection. Methods With a multi-state Markov model, fibrosis progression was evaluated in a well-characterized cohort of 143 AA and 157 CA adults with untreated chronic HCV genotype 1 infection. In subjects with a history of injection drug use, duration of infection was imputed from a fitted risk model rather than assumed to be the reported first year of use. Results The distribution of Ishak fibrosis stages was 0 (8.7%), 1/2 (55.7%), 3/4 (29.3%), and 5/6 (6.3%) and was similar in AAs and CAs ( P = .22). After adjusting for biopsy adequacy, AAs had a 10% lower rate of fibrosis progression than did CAs, but the difference was not statistically significant (hazard ratio, 0.90; 95% confidence interval, 0.72–1.12). The overall 20-year estimates of probabilities of progression from stage 0 to stages 1/2, 3/4, and 5/6 were 59.3%, 28.8%, and 4.7%, respectively. The estimated median time from no fibrosis to cirrhosis was 79 years for the entire cohort and 74 and 83 years for CAs and AAs, respectively. In 3-variable models including race and biopsy adequacy, the factors significantly associated with fibrosis progression were age when infected, steatosis, ALT level, and necroinflammatory score. Conclusions The rates of fibrosis progression were slow and did not appear to differ substantially between AAs and CAs.