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Racial differences in hepatitis C treatment eligibility

2011; Lippincott Williams & Wilkins; Volume: 54; Issue: 1 Linguagem: Inglês

10.1002/hep.24358

1527-3350

Michael T. Melia, Andrew J. Muir, Jonathan McCone, Mitchell L. Shiffman, John W. King, Steven K. Herrine, Greg Galler, Joseph R. Bloomer, Frederick A. Nunes, Kimberly Brown, Kevin D. Mullen, Natarajan Ravendhran, Reem Ghalib, Navdeep Boparai, Ruiyun Jiang, Stephanie Noviello, Clifford A. Brass, Janice K. Albrecht, John G. McHutchison, Mark Sulkowski,

Liver Disease Diagnosis and Treatment

Black Americans are disproportionally infected with hepatitis C virus (HCV) and are less likely than whites to respond to treatment with peginterferon (PEG-IFN) plus ribavirin (RBV). The impact of race on HCV treatment eligibility is unknown. We therefore performed a retrospective analysis of a phase 3B multicenter clinical trial conducted at 118 United States community and academic medical centers to evaluate the rates of and reasons for HCV treatment ineligibility according to self-reported race. In all, 4,469 patients were screened, of whom 1,038 (23.2%) were treatment ineligible. Although blacks represented 19% of treated patients, they were more likely not to be treated due to ineligibility and/or failure to complete required evaluations (40.2%) than were nonblack patients (28.5%; P < 0.001). After the exclusion of persons not treated due to undetectable HCV RNA or nongenotype 1 infection, blacks were 65% less likely than nonblacks to be eligible for treatment (28.1% > 17.0%; relative risk, 1.65; 95% confidence interval, 1.46-1.87; P < 0.001). Blacks were more likely to be ineligible due to neutropenia (14% versus 3%, P < 0.001), anemia (7% versus 4%, P = 0.02), elevated glucose (8% versus 3%, P < 0.001), and elevated creatinine (5% versus 1%, P < 0.001).