African Americans & HCV

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“Race” Matters
Researchers study disparities when it comes to African Americans & HCV
by Larry Buhl

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A growing number of clinicians and researchers want the African-American community to understand that not only is there a racial disparity in care and treatment, there are differences in the way HCV behaves in certain populations.

As part of the first African American Hepatitis C Action Day on July 25, the Harm Reduction Coalition, in partnership with the U.S. Department of Health and Human Services, Coalition on Positive Health Empowerment (COPE) and the National Black Leadership Commission on AIDS produced a Webinar spotlighting some of the issues involved with diagnosing and treating African Americans with HCV.

Some of the challenges addressed include:

• Participation in research. There are fewer African Americans in clinical trials.

• Access to care and insurance. African Americans are less likely to have insurance, and therefore less likely to seek treatment, testing or even go for check-ups with primary care physicians. This issue may be mitigated with the implementation of the Affordable Care Act, which has started enrolling lower-income customers.

Many clinical issues will sound familiar to those in the medical community struggling to get more black Americans tested and treated for HIV.

In addition to testing, research and treatment issues, there are several possibly genetic differences between African Americans and others in different racial categories vis-à-vis HCV infection, some of which still require more study to fully understand:

• Difficulty with older drugs. For pegylated interferon, there is a lower treatment response in African Americans.

• Neutropenia, or a low white blood cell count. A disproportionate number of African Americans with HCV have this but it’s not yet clear why.

• IL28B, a marker for patients who would respond to treatment. Response rates are not completely understood, but this is one thing that triggers the body to make natural interferon, Lambda. If you have this gene, you have a better chance to form an immune response. In some studies African Americans were less likely to have this gene variation.

• Finally there’s the HCV genotype strain (1-6). Roughly seventy-five percent of Americans infected with HCV have genotype 1 infection (ninety percent of blacks have this genotype). Having genotype 1 infection means that interferon and ribavirin therapy are recommended for forty-eight weeks, and that sustained virologic response (SVR) is in the range of fifty percent in patients treated with pegylated interferon and ribavirin who complete a full course of therapy. This rate may even be substantially lower (nineteen percent in one study) for African-American patients.

Panel participants said their Webinar was an opening for healthcare providers, community leaders, and policy makers to better understand the issues of African Americans and HCV. More study into race-based differences is necessary, they said, as well as more advocacy for testing and treatment in communities of color.

Christopher Bates did have some good news, informing participants that viral hepatitis would be part of the prevention component of the Affordable Care Act, meaning that patients should be covered for testing. Whether they actually do decide to get tested is another matter. Link to the Webinar here: http://bit.ly/1bDv7GP.

Race matters in liver transplants
In related news, a new study shows that African Americans with hepatitis C who are undergoing liver transplants have better outcomes when matched with donors of the same ethnic background. That’s according to a new study led by Dr. Nathan Shores, assistant professor of clinical medicine at Tulane University School of Medicine.

African-American hepatitis C liver transplant patients have poorer outcomes and lower five-year survival rates compared to other groups in different racial categories—that’s been well-known for years. What’s new is the finding from Shores’ study, which will be published in a future issue of Hepatology, that showed that when racially matched, black patients had long-term survival rates closer to those of other groups. Shores and researchers from University of California San Francisco analyzed data for more than 1,750 hepatitis C positive African-American patients, and found that a black patient with hepatitis C can live much longer if they receive a liver from a black donor.

The reason for the race-based difference is not known. Shores emphasizes that study in the field is preliminary, but he also says that there’s no need to wait for more data for potential donors from minority communities to step up.

African Americans comprised only fourteen percent of organ donors last year, yet twenty-nine percent of those waiting for transplants are black, according to the federal Office of Minority Health. Typically, doctors don’t consider the donor’s race or the recipient’s hepatitis status in evaluating whether a donated organ will survive in a potential transplant patient. More studies like this may bring more attention to race in transplants.

“If more African-Americans become donors in areas that have a lot of minority patients, it’s possible that they could help others who are at such a disadvantage when it comes to transplant survival,” Shores said in a prepared statement.

Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His young adult novel, The Genius of Little Things, debuted in January 2013.