Year: 2011
Type: article
Abstract: UNLABELLED: 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). CONCLUSION: Largely due to a higher prevalence of neutropenia and uncontrolled medical conditions, blacks were significantly less likely to be eligible for HCV treatment. Increased access to treatment may be facilitated by less conservative neutrophil requirements and more effective care for chronic diseases, namely, diabetes and renal insufficiency.
Source: Hepatology
DOI: 10.1002/hep.24358
Authors: Michael T. Melia, Andrew J. Muir, Jonathan McCone, Mitchell L. Shiffman, John W. King, Steven K. Herrine, Greg W. Galler, Joseph R. Bloomer, Frederick A. Nunes, Kimberly A. Brown, Kevin D. Mullen, Natarajan Ravendhran, Reem H. Ghalib, Navdeep Boparai, Ruiyun Jiang, Stephanie Noviello, Clifford A. Brass, Janice K. Albrecht, John G. McHutchison, Mark S. Sulkowski
Institutions: Johns Hopkins University, Duke University, Duke Medical Center, Bon Secours Health System, Louisiana State University Health Sciences Center Shreveport, Thomas Jefferson University, University of Alabama at Birmingham, Pennsylvania Hospital, Henry Ford Hospital, MetroHealth Medical Center, Digestive Health Associates of Texas, Texas Digestive Disease Consultants, Methodist Dallas Medical Center, Merck & Co., Inc., Rahway, NJ, USA (United States)
Language: English
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funder: National Cancer Institute
OpenAlex ID: W2153073992