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Blacks Respond Less to Hepatitis C Treatment

But they should still seek care, researchers say

WEDNESDAY, May 26, 2004 (HealthDayNews) -- For years, doctors treating patients with hepatitis C, a viral infection that can attack the liver, have noticed that black people tend to respond less to drug treatment.

Now, new research in the May 27 issue of the New England Journal of Medicine confirms what clinicians and several small studies have found: Black patients given a standard drug regimen had a lower response rate to treatment than did white patients.

Dr. Andrew J. Muir, a gastroenterologist at Duke University Medical Center, and his team gave 100 black patients and 100 non-Hispanic white patients the standard drug regimen of peginterferon alfa-2b and ribarvirin for the standard treatment time of 48 weeks.

>In the study, 52 percent of the white patients but only 19 percent of the blacks had what is called a sustained virologic response -- that means the virus level remained negative six months after the treatment stopped.

In previous research, experts had speculated blacks have a lower overall response to treatment because they are more likely to have a type of virus infection called genotype 1, which overall has a lower response rate than other genotypes.

"Genotype 1 is the most common in the United States," Muir said. "And African-Americans seem to have a higher prevalence of genotype 1 than other racial groups."

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"So we designed our study to try to account for the genotype issue," he added. "We did that by controlling the enrollment of the genotype 1 patients. We ended up with 98 percent genotype 1 black patients and 98 percent genotype 1 in the non-Hispanic white patients."

Even when controlling for the genotype, "blacks still had a lower response rate," he said.

Two previous studies, Muir said, had left hanging the question, is it race or genotype that accounts for the differences in response.

"This study confirms that it is race," Muir said.

Exactly why blacks tend to respond less favorably isn't known.

But the findings should not discourage black patients with hepatitis C from seeking treatment, Muir added. "I would want patients to know that even though we saw a lower response rate for African-American patients that many African-American patients do respond to therapy, and I do still recommend hepatitis C therapy to my African-American patients."

Evaluation is needed, however, to determine if treatment is necessary in every case, Muir said.

"Not everyone goes on to develop cirrhosis and liver cancer," he said. "So, we don't treat every patient. I biopsy and look to see if they have had significant damage to the liver. If yes, I advise treatment. If not, we discuss how they might want to consider waiting for treatment and maybe biopsy again [later]."

The study results bear out what another expert, Dr. Bennet Cecil, medical director of the Hepatitis C Treatment Center in Louisville, Ky., has seen in his years of treating patients. Even so, the study should not discourage black patients from seeking help, Cecil agreed.

"We're making advances against this [disease]," he said. "With the medicines we have today, we can cure about half of them [overall]." He defines cure as having an undetectable level of virus for the rest of your life.

Blacks should still seek care, said Dr. Gerond Lake-Bakaar, a physician at the Center for the Study of Hepatitis C at Cornell and Rockefeller University in New York City. "Because even though the likelihood of a cure is not as high as for whites, there is still the possibility of cure. Even though you may not be cured of this disease, there is still evidence that you delay the progression [with treatment]."

About 4 million Americans are infected with hepatitis C, according to the American Liver Foundation. And, the foundation estimates, about 85 percent of those infected each year will develop chronic infection.

At risk are individuals who come into contact with infected blood, instruments or needles, such as health-care workers and drug users. Other potential risks include intranasal cocaine use, tattooing and body piercing. There is no vaccine.

More information

To learn more about hepatitis C, visit the Hepatitis Foundation International.

SOURCES: Andrew J. Muir, M.D., M.H.S., assistant professor, medicine, gastroenterologist, Duke University Medical Center, Durham, N.C.; Bennet Cecil, M.D., medical director, Hepatitis C Treatment Center, Louisville, and staff physician, Louisville VAMC, Louisville, Ky.; Gerond Lake-Bakaar, M.D., associate professor, medicine, Cornell University Medical College, and physician, Center for the Study of Hepatitis C, Cornell and Rockefeller Universities; May 27, 2004, New England Journal of Medicine
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