Prior studies have shown that Blacks experience a lower sustained viral response rate (SVR) from treatment with interferon/ribavirin (RBV) than non-Blacks. In addition, Blacks have shown a higher frequency of infection with HCV genotype 1 (GT-1) infection, the most difficult-to-treat type of hepatitis C virus infection.

In the current prospective, community-based study at multiple US medical centers, researchers sought to determine whether Blacks have a lower SVR rate independent of their HCV genotype (emphasis added--Ed).

Results

785 patients were enrolled (24.8% Black, 71.5% White, 3.7% others).

Participants received conventional interferon alfa-2b (Intron A) 3 MU three times weekly + RBV 1000–1200 mg/day for 24 weeks (GT-2/3) or 48 weeks (GT-1).

Black patients were more commonly infected with GT-1 (86.8%vs 64.8%, P < 0.001) and less frequently had an SVR compared with non-Black patients (8.4%vs 21.6%, P < 0.001).

Within GT-1, Black patients had a lower SVR rate than non-Black patients (6.1%vs 14.1%, P = 0.004) but not within GT-2/3 (50.0%vs 36.5%, P = 0.47).

Black patients had lower baseline hemoglobin levels (14.8 vs 15.3 g/dL, P < 0.001) and neutrophil counts (2900 vs 4100/mm³, P < 0.001) and required more frequent dose reductions of RBV (29.8%vs 18.5%, P < 0.001) and interferon (4.7%vs 1.6%, P = 0.012).

However, dose reductions were not associated with lower SVR rates while early treatment discontinuations were (2.9%vs 25.7%, P < 0.001).

Independent predictors of SVR were GT-1 (P < 0.001), Black race (P = 0.030), and advanced fibrosis, stages 3 + 4 (P = 0.023).

In conclusion, the authors write, “Black patients infected with HCV GT-1 (but not GT-2/3) have a lower SVR rate than non-Black patients. This is not explained by their lower baseline hemoglobin levels and neutrophil counts that lead to higher rates of ribavirin and interferon dose reductions.”

04/04/06

Reference
N Bräu, EJ Bini, S Currie and others (The VA-HCV-001 Study Group). Black patients with chronic hepatitis C have a lower sustained viral response rate than non-Blacks with genotype 1, but the same with genotypes 2/3, and this is not explained by more frequent dose reductions of interferon and ribavirin. Journal of Viral Hepatitis 13(4): 242-249. April 2006.

FDA-approved Monotherapies for HCV

Intron A Roferon Infergen Pegasys PEG-Intron

FDA-approved Combination Therapies for HCV

Pegasys + Copegus PEG-Intron + Rebetol Intron A + Rebetol Roferon A + Ribavirin