Treating hepatitis C in African Americans

Background: The epidemiology, natural history and response to therapy of chronic hepatitis C differs significantly between African Americans and other ethnic populations. The reasons for these differences are not entirely clear but include mode of transmission, viral kinetics, immune responsiveness, and demographics. Objective: Review of the peer-reviewed literature and expert opinion from 1990 to 2005 regarding features of hepatitis C virus (HCV) infection in African Americans, differences in presentation and response to therapy, and treatment recommendations. Results: The epidemiology of HCV infection in African Americans appears to be predominantly associated with socio-economic status and high-risk behaviors. However, disease course, response to treatment, and virologic outcome may be a function of race. African Americans may clear HCV less efficiently than other ethnic groups, although impaired immune responsivity may also lead to decreased necro-inflammatory activity and progression to cirrhosis. Therapy-naive African Americans have lower sustained virologic response rates to this treatment than other populations. Conclusions: Strategies to improve outcomes in African Americans include higher doses of current medications, medications with fewer adverse events, and new experimental molecular therapies.