Hispanic Race/Ethnicity is Associated with an Aggressive Course of Chronic Hepatitis C Infection: Role of Patient Demographics, Hepatic Steatosis and Necroinflammation.
s. Verma, University of Southern California, Los Angeles, CA, M. Bonacini, California pacific Medical Center, San Francisco, CA, S. Govindarajan, Rancho Los Amigos Center, Downey, CA, G. Kanel, University of Southern California, Los Angeles, CA, K. Lindsay, University of Southern California, Los Angeles, CA, A. Redeker, Rancho Los Amigos MEdical Center, Downey, CA
Background and aims:
There is very little data available on patient demographics and liver histology in Hispanic patients with chronic hepatitis C (HCV) infection. The aim of this study was to analyze the severity of HCV related liver disease amongst the Hispanics compared to other race/ethnic groups. Patients and methods: patients were recruited fromthe Los Angeles County Hepatitis Clinic. Race/ethnicity was classified as: Non Hispanic Whites (NHW), Hispanics and Others (Blacks and Asians). Liver fibrosis and necroinflammatory score were assessed by the Ishak scoring system. Hepatic steatosis was graded as 0-4.
296 patients were found suitable for the study (NHW =63, Hispanic =169 and Others =64). Hispanics were older at exposure due to higher prevalence of blood transfusion as a risk factor (p<0.007 vs NHW). They also had significantly higher fibrosis stage (3.3 + 2 vs 2.3 + 6.9, p=0.001), necroinflammatory score (6.4 +1.8 vs 5.6 + 1.6, p=0.002) and faster fibrosis progression (0.14 + 0.09/yr vs 0.09 + 0.07/yr), (p=0.0002 vs NHW). Prevalence of obesity (52%) and hepatic steatosis (77%) was highest in Hispanics vs NHW (22% and 47%) and Others (31% and 47%), p<0.004. Mean steatosis grade (1.1 vs 0.6) was also higher in Hispanics vs NHW and Others, p<0.0003. Non-NHW ethnicity, OR 1.8 (95% CI 1.0-3.5), p=0.08, and necroinflammatory score, OR 1.6 (95% CI 1.3-1.8), p<0.0001 were independent predictors of fibrosis stage > 4. Hispanic ethnicity was an independent predictor of both NI score > 7 (OR 1.7 (95% CI 1.0-2.8), p=0.05) and hepatic steatosis (OR 3.0 (95% CI 1.6-5.6), p=0.0007. A significant correlation was observed between fibrosis stage and both NI score (r=0.45, p<0.001) and hepatic steatosis (r=0.21, p=0.001).
Hispanics have an aggressive course of HCV infection compared to NHW. This may be related to older age at exposure, higher necroinflammatory scores and prevalence of hepatic steatosis. Race/ethnicity is an important variable that should be weighed in when deciding treatment options for patients with HCV infection.
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