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NIH Record

NIDDK Workshop Examines Hepatitis C in African-Americans

By Leslie Curtis

Although there has been a four-fold decline in new cases of hepatitis C (HCV) in the U.S. population since 1989, identified cases of chronic HCV are rising, particularly in African-Americans. The highest observed rate of HCV infection among all racial and ethnic groups is among Black males ages 40-49. They have a 9 percent rate of hepatitis C, according to researchers attending a recent NIH workshop on HCV in African-Americans. Researchers also report that the onset of infection occurs at earlier ages in Blacks and, as a result, Blacks are infected longer.

"These general findings help crystallize some of our suspicions about racial differences of this disease," said meeting cosponsor Dr. Jay H. Hoofnagle, director, Division of Digestive Diseases and Nutrition, NIDDK. "But prospective studies that focus on complications, natural history, therapy and prevention involving African-Americans and hepatitis C are still needed to confirm or disprove our suspicions."

According to the Centers for Disease Control and Prevention, 3.9 million Americans have been exposed to hepatitis C. Of these, 2.7 million are chronically infected with the virus. Hepatitis C is primarily spread by exposure to contaminated blood and blood products, with injection drug use now being the most common route of disease transmission.

CDC epidemiologist Dr. Miriam Alter said that even though sexual encounters account for 10 percent to 20 percent of HCV cases, they are an inefficient route of transmission that is difficult to assess because a health care provider does not know the number of infected sex partners a person has had.

Workshop participants also discussed how different races respond to interferon treatment. Although most studies reviewed included a limited number of African-Americans, data from such diverse sites as the Miami Veterans Medical Center and the NIH Clinical Center indicate that African-Americans respond to interferon at lower rates than Caucasians. The factors responsible for the different response rates between racial groups are unknown.

"The fact that African-Americans are more likely to be infected with genotype 1b may also account for their poor response to treatment," said Dr. K. Rajender Reddy, professor, University of Miami. Future clinical trials using interferon and ribavirin may help determine whether combination therapy is more effective in African-Americans.

Another topic of interest was increasing African-American participation in clinical research, particularly hepatitis studies. The researchers acknowledged that the lack of African-American participation in clinical research greatly limits researchers' understanding of the disease and how to treat it in this population. Numerous issues such as patient distrust of the medical community, rigid treatment schedules and lack of community outreach training for health professionals contribute to the low representation.

To begin to address these issues, researchers need to get to know the designated community and work with its local leaders such as ministers, said Dr. Claudia Baquet, associate dean, University of Maryland, Baltimore. "African-Americans are interested in participating, but you need to build relationships with them before they are needed for a clinical trial."

As a result of the workshop, NIH plans to support several research initiatives in hepatitis C focused on genetic and virological markers that determine natural history and treatment outcomes. Organizers plan to publish a summary in coming months.

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