A team from Chicago, Illinois, USA, determined the natural history of hepatitis C virus (HCV) infection in African Americans.
The demographics, mode of infection, virological features, and histological progression of HCV infection in African Americans versus non-African Americans were retrospectively examined.
A total of 355 patients met criteria based on adequate liver biopsy specimens and exclusion of other hepatic diseases.
African Americans (n = 112) were found to be significantly more likely to be infected with genotype 1 virus (88%) than were non-African Americans (n = 243, 67%).
Baseline HCV RNA levels were similar, although baseline ALT values were significantly lower in African Americans (80 µl vs 112 µl).
African Americans were also significantly older at the time of presentation and were significantly more likely to be women.
|Patients with cirrhosis:|
African Americans: 22%
Non-African Americans: 30%
| American Journal of Gastroenterology |
The researchers found that, in African Americans, there was a trend toward less cirrhosis (22% vs 30%) and significantly less piecemeal necrosis on liver biopsy.
Non-African Americans had significantly higher fibrosis scores, ALT values, and piecemeal necrosis ratings, and tended to progress more rapidly to cirrhosis.
This difference in histological progression between the two groups was not explained by differences in alcohol consumption.
Dr T. E. Wiley, of the College of Pharmacy, at the University of Illinois at Chicago, concluded on behalf of fellow authors, "The lower ALT, piecemeal necrosis scores, and slower progression of fibrosis in African Americans may reflect less immunological recognition of HCV-infected liver cells."
In an accompanying Editorial, Drs Damien B. Mallat and Lennox Jeffers point out that the study addresses a very important and lingering issue in the natural history of HCV.
"Even though HCV infection in African Americans might have less immune recognition, which results in a slower disease progression, this issue needs further exploration in a randomized, controlled trial," they comment.
"Only a few studies have been done to evaluate the natural history of HCV in African Americans. This underrepresentation has been detrimental to our understanding of the HCV epidemic in this group," they concluded.