Racial differences in hepatitis C treatment eligibility

Michael 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 Sulkowski

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)70-78
Number of pages9
JournalHepatology
Volume54
Issue number1
DOIs
Publication statusPublished - Jul 2011

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ASJC Scopus subject areas

  • Hepatology

Cite this

Melia, M., Muir, A. J., Mccone, J., Shiffman, M. L., King, J. W., Herrine, S. K., ... Sulkowski, M. (2011). Racial differences in hepatitis C treatment eligibility. Hepatology, 54(1), 70-78. https://doi.org/10.1002/hep.24358