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Racial differences in hepatitis C treatment eligibility
Author(s) -
Melia Michael T.,
Muir Andrew J.,
McCone Jonathan,
Shiffman Mitchell L.,
King John W.,
Herrine Steven K.,
Galler Greg W.,
Bloomer Joseph R.,
Nunes Frederick A.,
Brown Kimberly A.,
Mullen Kevin D.,
Ravendhran Natarajan,
Ghalib Reem H.,
Boparai Navdeep,
Jiang Ruiyun,
Noviello Stephanie,
Brass Clifford A.,
Albrecht Janice K.,
McHutchison John G.,
Sulkowski Mark S.
Publication year - 2011
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.24358
Subject(s) - medicine , neutropenia , ribavirin , confidence interval , anemia , hepatitis c , hepatitis c virus , gastroenterology , immunology , chemotherapy , virus
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. (H EPATOLOGY 2011;)