Thursday, August 3, 2017

Ethnic disparities in progression to advanced liver disease and overall survival in patients with chronic hepatitis C: impact of SVR

Of Interest
Steatosis: An Independent Risk Factor for Fibrosis in Chronic HCV
A study recently published in Digestive Disease Science found that hypertension, older age, obesity, and HIV are risk factors and that steatosis is an independent risk factor for liver fibrosis in African-Americans with chronic hepatitis C.

Aliment Pharmacol Ther. 2017;112.
Ethnic disparities in progression to advanced liver disease and overall survival in patients with chronic hepatitis C: impact of a sustained virological response
A. K. Le, C. Zhao, J. K. Hoang, S. A. Tran, C. Y. Chang, M. Jin, N. H. Nguyen, L. A. Yasukawa, J. Q. Zhang, S. C. Weber, G. Garcia, M. H. Nguyen

First published: 2 August 2017
DOI: 10.1111/apt.14241

View Full Text Article 

In summary, our study found Hispanic and Asian patients to have a higher risk of developing cirrhosis and HCC compared to Caucasian patients. With successful achievement of SVR, these ethnic disparities no longer hold significance, and rates of disease progression in all groups were reduced. Our results underscore the importance of early diagnosis, linkage to care and anti-viral therapy for CHC patients of all ethnic backgrounds. Lastly, while SVR was effective in eliminating the racial disparities and reducing the incidence of cirrhosis and HCC for all ethnicities, there were still a number of patients found to develop cirrhosis and HCC following SVR. Thus, we advocate for continued regular follow-up and HCC surveillance for CHC patients with advanced fibrosis or cirrhosis even after successful SVR. Further research is needed to identify clinical and genetic factors predisposing patients to continued disease progression and HCC development despite SVR.

Summary
Background
Chronic hepatitis C (CHC) can lead to cirrhosis and hepatocellular carcinoma (HCC). A sustained virological response (SVR) is associated with improved outcomes, however, its impact on different ethnic groups is unknown.

Aim
To evaluate ethnic differences in the natural history of CHC and the impact of SVR.

Methods
We conducted a cohort study of 8039 consecutive adult CHC patients seen at two medical centres in California between January 1997 and June 2016. Individual chart review confirmed CHC diagnosis.

Results
Asian and Hispanic but not African American patients had significantly higher cirrhosis and HCC incidence than Caucasians. On multivariate analysis, Hispanic ethnicity was independently associated with increased cirrhosis (adjusted HR 1.37, CI, confidence interval 1.10-1.71, P=.006) and HCC risk (adjusted HR 1.47, CI 1.13-1.92, P=.004) compared to Caucasian. Asian ethnicity had a significant association with cirrhosis (adjusted HR 1.28, CI 1.02-1.61, P=.034) and HCC risk (adjusted HR 1.29, CI 0.94-1.77, P=.025). In patients who achieved SVR, Hispanic ethnicity was no longer independently associated with cirrhosis (adjusted HR 1.76, CI 0.66-4.71, P=.26) or HCC (adjusted HR 1.05, CI 0.27-4.08, P=.94); nor was Asian ethnicity (adjusted HR 0.62, CI 0.21-1.82, P=.38 for cirrhosis; 2.01, CI 0.63-6.36, P=.24 for HCC). Similar findings were observed with overall survival among the ethnicities by SVR status.

Conclusion
Hispanic and Asian ethnicity was independently associated with increased cirrhosis and HCC risk. Achieving an SVR eliminates the ethnic disparity in liver disease progression and overall survival between Hispanic and Asian vs Caucasian CHC patients.

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