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The Association of Race/Ethnicity, Sex, and Comorbidity with Hepatitis C Genotype 1 Treatment Response
The Internet Journal of Gastroenterology, 06/30/09

Marks DH et al. - Studies have shown a negative contribution of many underlying and or concurrent medical conditions to the response rate for HCV. Several of these co-morbid conditions (DM, HTN, obesity, elevated cholesterol) have a particularly high prevalence in the AA community.

Exclusive Author Commentary
Donald H. Marks, MD PhD, 07/01/09

Most studies comparing the response of African American (AA) patients to other groups for treatment of hepatitis C virus (HCV) have been performed in academic centers in the setting of clinical trials. In general, AA patients have lower response rates that are only partially explained by unfavorable prognostic factors, such as infection with genotype 1, high viral load, insulin resistance, obesity, hypertension, and others. We examined response rates associated with these adverse prognostic factors within race/ethnicity-sex strata for a cohort of patients treated at a inner -city hospital-based, safety-net clinic. From 2004-2008, 88 evaluable AA and 30 other patients received standard therapy for HCV consisting of weekly injections of peg interferon alfa-2 plus oral weight-based ribavirin. The predicted probability of a favorable virologic outcome ranged from 89.0% (95% CI: 63.7% = 97.3%) for other females to 4.1% (95% CI: 0.9% - 17.9%) for AA females. We concluded that important interactions occur among race/ethnicity, sex, and co-morbidity in response to HCV therapy. Increasing co-morbidity places AA patients at greatest risk of nonresponse and raises the possibility that more aggressive treatment of co-morbidity might increase response rates in the vulnerable patients.

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