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Maqsood H, Chughtai T, Khan AB, Younus S, Abbas A, Akbar UA, Qazi S. Association of Lipid and Body Mass Index Profile With Chronic Hepatitis C Infection Stratified by Age and Gender. Cureus 2021; 13:e20665. [PMID: 35103215 PMCID: PMC8784145 DOI: 10.7759/cureus.20665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 12/16/2022] Open
Abstract
Background In this study, we aimed to determine the association of lipid and body mass index (BMI) profiles among cases having chronic hepatitis C virus (CHCV) infection. Methodology This cross-sectional study was conducted in the outpatient department of a tertiary care hospital. A total of 320 cases of both genders, aged 18 to 60 years, with CHCV infection were enrolled in the study. After obtaining relevant history and conducting a physical examination, the venous blood sample of each patient was taken and sent to the institutional laboratory to analyze serum total cholesterol, serum triglyceride, low-density lipoprotein, and high-density lipoprotein levels. BMI of all the study participants was also noted. Results Of the total 320 cases, there were 152 (47.5%) males and 168 (52.5%) females. The overall mean age was 42.92 ± 11.38 years. Most cases [97 (30.3%)] were in the 41 to 50-year age group. Overall, the mean BMI was 27.75 ± 4.59 kg/m2. Dyslipidemia was noted in 144 (45.0%) cases. Increasing age and increasing BMI were found to have statistical significance with the presence of dyslipidemia (p < 0.05). Conclusions Increasing age and BMI have a significant association with dyslipidemia in patients with CHCV infection. Lipid profile appears to differ among different age and BMI groups.
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Wong RJ, Hirode G. The Effect of Hospital Safety-Net Burden and Patient Ethnicity on In-Hospital Mortality Among Hospitalized Patients With Cirrhosis. J Clin Gastroenterol 2021; 55:624-630. [PMID: 33136780 DOI: 10.1097/mcg.0000000000001452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Over 2.1 million individuals in the United Stats have cirrhosis, including 513,000 with decompensated cirrhosis. Hospitals with high safety-net burden disproportionately serve ethnic minorities and have reported worse outcomes in surgical literature. No studies to date have evaluated whether hospital safety-net burden negatively affects hospitalization outcomes in cirrhosis. We aim to evaluate the impact of hospitals' safety-net burden and patients' ethnicity on in-hospital mortality among cirrhosis patients. METHODS Using National Inpatient Sample data from 2012 to 2016, the largest United States all-payer inpatient health care claims database of hospital discharges, cirrhosis-related hospitalizations were stratified into tertiles of safety-net burden: high (HBH), medium (MBH), and low (LBH) burden hospitals. Safety-net burden was calculated as percentage of hospitalizations per hospital with Medicaid or uninsured payer status. Multivariable logistic regression evaluated factors associated with in-hospital mortality. RESULTS Among 322,944 cirrhosis-related hospitalizations (63.7% white, 9.9% black, 15.6% Hispanic), higher odds of hospitalization in HBHs versus MBH/LBHs was observed in blacks (OR, 1.26; 95%CI, 1.17-1.35; P<0.001) and Hispanics (OR, 1.63; 95% CI, 1.50-1.78; P<0.001) versus whites. Cirrhosis-related hospitalizations in MBHs or HBHs were associated with greater odds of in-hospital mortality versus LBHs (HBH vs. LBH: OR, 1.05; 95% CI, 1.00-1.10; P=0.044). Greater odds of in-hospital mortality was observed in blacks (OR, 1.27; 95% CI, 1.21-1.34; P<0.001) versus whites. CONCLUSION Cirrhosis patients hospitalized in HBH experienced 5% higher mortality than those in LBH, resulting in significantly greater deaths in cirrhosis patients. Even after adjusting for safety-net burden, blacks with cirrhosis had 27% higher in-hospital mortality compared with whites.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA
| | - Grishma Hirode
- Toronto Centre for Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, Canada
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Abstract
Chronic hepatitis C viral (HCV) infection continues to carry a high burden of disease despite recent and emerging advancements in treatment. The persistently high prevalence of HCV is attributed to the rising opioid epidemic, with a history of injection drug use as the primary risk factor for infection. As a result, the epidemiology of HCV-infected individuals is changing. Previously a disease of "Baby Boomers," males, and non-Hispanic blacks, the new generation of patients with HCV includes younger adults from 20 to 39 years of age, both men and women similarly represented, and non-Hispanic whites. Shifting trends in these demographics may be attributed to the use of injection drugs, which also has suggested impact on fibrosis progression in infected individuals. Awareness of the changing face of HCV is necessary to expand and revise recommendations regarding screening, outreach, and care engagement of infected individuals, in order to best identify patients at-risk for infection.
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Affiliation(s)
- Tiffany Wu
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Peter G Konyn
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Austin W Cattaneo
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Sammy Saab
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. .,Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA. .,Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA.
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Turner BJ, Wang CP, Melhado TV, Bobadilla R, Jain MK, Singal AG. Significant Increase in Risk of Fibrosis or Cirrhosis at Time of HCV Diagnosis for Hispanics With Diabetes and Obesity Compared With Other Ethnic Groups. Clin Gastroenterol Hepatol 2019; 17:1356-1363. [PMID: 30529733 DOI: 10.1016/j.cgh.2018.11.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Advanced liver disease, which includes fibrosis and cirrhosis, has been reported to be more prevalent in Hispanics patients at the time of diagnosis of chronic hepatitis C virus (HCV) infection than non-Hispanic black or non-Hispanic white patients. We performed a propensity score-matched analysis to determine whether metabolic risk factors contribute to this disparity. METHODS We collected data from persons with 748 HCV infection (22% Hispanic, 53% non-Hispanic black, and 26% non-Hispanic white; 23% with advanced liver disease), born from 1945 through 1965, diagnosed at 6 health care systems in Texas. Advanced liver disease was defined as a FIB-4 index score above 3.25. We examined the association between advanced liver disease and race or ethnicity, metabolic risk (based on diabetes mellitus and body mass index [BMI]) and heavy alcohol use in propensity score-matched analyses. RESULTS In propensity-score matched models, among those who were obese (BMI ≥30) with a diagnosis of diabetes, the adjusted odds ratio of advanced liver disease for Hispanics vs non-Hispanic black was 7.89 (95% CI, 3.66-17.01) and adjusted odds ratio = 12.49 (95% CI, 3.24-48.18) for Hispanic vs non-Hispanic white patients (both P < .001). CONCLUSIONS HCV-infected Hispanics with obesity and diabetes have a far higher risk for advanced liver disease than other racial or ethnic groups. These findings highlight the need for HCV treatment and management of probable concurrent fatty liver disease. Even after we accounted for metabolic risk factors, Hispanics were still at higher risk for advanced liver disease, indicating the potential involvement of other factors such as genetic variants.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Chen-Pin Wang
- Department of Epidemiology and Biostatistics, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Trisha V Melhado
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Raudel Bobadilla
- Center for Research to Advance Community Health (ReACH), University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Mamta K Jain
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
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5
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Zhang Y, Boktour MR. The Impact of Share 35 Policy on Patient Survival in Patients Undergoing Liver Transplantation With Gender- and Race-Mismatched Donors: An Analysis of the United Network for Organ Sharing Registry. Prog Transplant 2018; 28:151-156. [PMID: 29558873 DOI: 10.1177/1526924818765802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The United Network for Organ Sharing (UNOS) instituted the Share 35 policy in June 2013 in order to reduce death on liver transplant waitlist. The effect of this policy on patient survival among patients with gender- and race-mismatched donors has not been examined. RESEARCH QUESTION To assess the impact of Share 35 policy on posttransplantation patient survival among patients with end-stage liver disease (ESLD) transplanted with gender- and race-mismatched donors. DESIGN A total of 16 467 adult patients with ESLD who underwent liver transplantation between 2012 and 2015 were identified from UNOS. An overall Cox proportional hazards model adjusting for demographic, clinical, and geographic factors and separate models with a dummy variable of pre- and post-Share 35 periods as well as its interaction with other factors were performed to model the effect of gender and race mismatch on posttransplantation patient survival and to compare the patient survival differences between the first 18 months of Share 35 policy to an equivalent time period before. RESULTS Comparison of the pre- and post-Share 35 periods did not show significant changes in the numbers of gender- and race-mismatched transplants, or the risk of death for gender-mismatched recipients. However, black recipients with Hispanic donors (hazard ratio: 0.51, 95% confidence interval, 0.29-0.90) had significantly increased patient survival after Share 35 policy took effect. CONCLUSION The Share 35 policy had a moderate impact on posttransplantation patient survival among recipients with racially mismatched donors according to the first 18-month experience. Future research is recommended to explore long-term transplantation.
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Affiliation(s)
- Yefei Zhang
- 1 Department of Biostatistics, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Maha R Boktour
- 2 Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
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Pinon-Gutierrez R, Durbin-Johnson B, Halsted CH, Medici V. Clinical features of alcoholic hepatitis in latinos and caucasians: A single center experience. World J Gastroenterol 2017; 23:7274-7282. [PMID: 29142474 PMCID: PMC5677196 DOI: 10.3748/wjg.v23.i40.7274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/19/2017] [Accepted: 09/26/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To study differences of presentation, management, and prognosis of alcoholic hepatitis in Latinos compared to Caucasians.
METHODS We retrospectively screened 876 charts of Caucasian and Latino patients who were evaluated at University of California Davis Medical Center between 1/1/2002-12/31/2014 with the diagnosis of alcoholic liver disease. We identified and collected data on 137 Caucasians and 64 Latinos who met criteria for alcoholic hepatitis, including chronic history of heavy alcohol use, at least one episode of jaundice with bilirubin ≥ 3.0 or coagulopathy, new onset of liver decompensation or acute liver decompensation in known cirrhosis within 12 wk of last drink.
RESULTS The mean age at presentation of alcoholic hepatitis was not significantly different between Latinos and Caucasians. There was significant lower rate of overall substance abuse in Caucasians compared to Latinos and Latinos had a higher rate of methamphetamine abuse (12.5% vs 0.7%) compared to Caucasians. Latinos had a higher mean number of hospitalizations (5.3 ± 5.6 vs 2.7 ± 2.7, P = 0.001) and mean Emergency Department visits (9.5 ± 10.8 vs 4.5 ± 4.1, P = 0.017) for alcohol related issues and complications compared to Caucasians. There was significantly higher rate of complications of portal hypertension including gastrointestinal bleeding (79.7% vs 45.3%, P < 0.001), spontaneous bacterial peritonitis (26.6% vs 9.5%, P = 0.003), and encephalopathy (81.2% vs 55.5%, P = 0.001) in Latinos compared to Caucasians.
CONCLUSION Latinos have significant higher rates of utilization of acute care services for manifestations alcoholic hepatitis and complications suggesting poor access to outpatient care.
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Affiliation(s)
- Rogelio Pinon-Gutierrez
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, Sacramento, CA 95817, United States
| | - Blythe Durbin-Johnson
- Division of Biostatistics University of California Davis, Department of Public Health Sciences, Davis, CA 95616, United States
| | - Charles H Halsted
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, Sacramento, CA 95817, United States
| | - Valentina Medici
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, Sacramento, CA 95817, United States
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Isolated Hepatitis B Core Antibody Status Is Not Associated With Accelerated Liver Disease Progression in HIV/Hepatitis C Coinfection. J Acquir Immune Defic Syndr 2017; 72:274-80. [PMID: 26918547 DOI: 10.1097/qai.0000000000000969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Isolated hepatitis B core antibody (anti-HBc) is a common serologic finding in HIV-infected persons, but the clinical significance is uncertain. We studied HIV/hepatitis C virus (HCV)-infected women over time to determine whether the trajectory of liver disease progression is affected by isolated anti-HBc serologic status. METHODS We performed serial enhanced liver fibrosis (ELF) markers on HIV/HCV-coinfected women to assess liver disease progression trajectory over time comparing women with isolated anti-HBc to women with either negative HB serologies, anti-HBs alone, or anti-HBc and anti-HBs. ELF, a serum marker that combines direct markers of extracellular matrix remodeling and fibrosis, was performed on serum stored biannually. Women with at least 3 ELF determinations and persistent HCV RNA positivity were included. RESULTS Three hundred forty-four women, including 132 with isolated anti-HBc and 212 with other serologic findings, were included. A median of 6 (interquartile range, 5-7) biannual ELF values was available for each woman, totaling 2119 visits. ELF increased over time from a median of 9.07 for women with isolated anti-HBc and 9.10 for those without isolated anti-HBc to 9.83 and 9.88, respectively, with no difference in degree of change or slope in the mixed-effects model including age, race, CD4 count, antiretroviral therapy, and drug and alcohol use. Factors independently associated with liver disease progression were older age, lower CD4, antiretroviral therapy nonuse, and Hispanic ethnicity. CONCLUSION Isolated anti-HBc serologic status was not associated with accelerated liver disease progression over a median of 9.5 years among HIV/HCV-coinfected women.
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Hiramatsu K, Matsuda H, Nemoto T, Nosaka T, Saito Y, Naito T, Takahashi K, Ofuji K, Ohtani M, Suto H, Yasuda T, Hida Y, Kimura H, Soya Y, Nakamoto Y. Identification of novel variants in HLA class II region related to HLA DPB1 expression and disease progression in patients with chronic hepatitis C. J Med Virol 2017; 89:1574-1583. [PMID: 28332201 DOI: 10.1002/jmv.24814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 03/01/2017] [Indexed: 02/06/2023]
Abstract
Recent genome-wide studies have demonstrated that HLA class II gene may play an important role in viral hepatitis. We studied genetic polymorphism and RNA expression of HLA class II genes in HCV-related liver diseases. The study was performed in groups consisting of 24 patients with HCV-related liver disease (12 of persistent normal ALT: PNALT group and 12 of advanced liver disease: ALD group) and 26 patients without HCV infection (control group). In PBMC samples, RNA expression of HLA class II genes (HLA-DPA1, DPB1, DQA1, DQB1, and DRB1) was analyzed by real-time RT-PCR. Furthermore, 22 single nucleotide polymorphisms (SNPs) in HLA class II gene and two SNPs in IL28B gene were genotyped by genetic analyzer (GENECUBE®). In expression analysis, only DPB1 level was significantly different. Mean expression level of DPB1gene in control group was 160.0, PNALT group 233.8, and ALD group 465.0 (P < 0.01). Of 24 SNPs, allele frequencies were statistically different in two SNPs (rs2071025 and rs3116996) between PNALT groups and ALD group (P < 0.01). In rs2071025, TT genotype was frequently detected in ALD group and expression level was significantly higher than the other genotypes (449.2 vs 312.9, P < 0.01). In rs3116996, TA or TT (non AA) genotype was frequently detected in ALD group and expression level was significantly higher than genotype AA (457.1 vs 220.9, P < 0.01). Genotyping and expression analysis in HLA class II gene revealed that two SNPs of HLA-DPB1 (rs2071025 and rs3116996) were significantly correlated to RNA expression and progression of HCV-related liver diseases.
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Affiliation(s)
- Katsushi Hiramatsu
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
| | - Hidetaka Matsuda
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
| | - Tomoyuki Nemoto
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
| | - Takuto Nosaka
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
| | - Yasushi Saito
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
| | - Tatsushi Naito
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
| | - Kazuto Takahashi
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
| | - Kazuya Ofuji
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
| | - Masahiro Ohtani
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
| | - Hiroyuki Suto
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
| | - Toshihiro Yasuda
- Faculty of Medical Sciences, Division of Medical Genetics and Biochemistry, University of Fukui, Fukui, Japan
| | - Yukio Hida
- Faculty of Medical Sciences, Department of Clinical Laboratories, University of Fukui, Fukui, Japan
| | - Hideki Kimura
- Faculty of Medical Sciences, Department of Clinical Laboratories, University of Fukui, Fukui, Japan
| | - Yoshihiro Soya
- Tsuruga Institute of Biotechnology, Toyobo Co., Ltd., Osaka, Japan
| | - Yasunari Nakamoto
- Faculty of Medical Sciences, Second Department of Internal Medicine, University of Fukui, Fukui, Japan
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Venepalli NK, Modayil MV, Berg SA, Nair TD, Parepally M, Rajaram P, Gaba RC, Bui JT, Huang Y, Cotler SJ. Features of hepatocellular carcinoma in Hispanics differ from African Americans and non-Hispanic Whites. World J Hepatol 2017; 9:391-400. [PMID: 28321275 PMCID: PMC5340994 DOI: 10.4254/wjh.v9.i7.391] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/29/2016] [Accepted: 01/18/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To compare features of hepatocellular carcinoma (HCC) in Hispanics to those of African Americans and Whites.
METHODS Patients treated for HCC at an urban tertiary medical center from 2005 to 2011 were identified from a tumor registry. Data were collected retrospectively, including demographics, comorbidities, liver disease characteristics, tumor parameters, treatment, and survival (OS) outcomes. OS analyses were performed using Kaplan-Meier method.
RESULTS One hundred and ninety-five patients with HCC were identified: 80.5% were male, and 22% were age 65 or older. Mean age at HCC diagnosis was 59.7 ± 9.8 years. Sixty-one point five percent of patients had Medicare or Medicaid; 4.1% were uninsured. Compared to African American (31.2%) and White (46.2%) patients, Hispanic patients (22.6%) were more likely to have diabetes (P = 0.0019), hyperlipidemia (P = 0.0001), nonalcoholic steatohepatitis (NASH) (P = 0.0021), end stage renal disease (P = 0.0057), and less likely to have hepatitis C virus (P < 0.0001) or a smoking history (P < 0.0001). Compared to African Americans, Hispanics were more likely to meet criteria for metabolic syndrome (P = 0.0491), had higher median MELD scores (P = 0.0159), ascites (P = 0.008), and encephalopathy (P = 0.0087). Hispanic patients with HCC had shorter OS than the other racial groups (P = 0.020), despite similarities in HCC parameters and treatment.
CONCLUSION In conclusion, Hispanic patients with HCC have higher incidence of modifiable metabolic risk factors including NASH, and shorter OS than African American and White patients.
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10
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Matsuda T, McCombs JS, Tonnu-Mihara I, McGinnis J, Fox DS. The Impact of Delayed Hepatitis C Viral Load Suppression on Patient Risk: Historical Evidence from the Veterans Administration. ACTA ACUST UNITED AC 2016; 19:333-351. [DOI: 10.1515/fhep-2015-0041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract
Background:
The high cost of new hepatitis C (HCV) treatments has resulted in “watchful waiting” strategies being developed to safely delay treatment, which will in turn delay viral load suppression (VLS).
Objective:
To document if delayed VLS adversely impacted patient risk for adverse events and death.
Methods:
187,860 patients were selected from the Veterans Administration’s (VA) clinical registry (CCR), a longitudinal compilation of electronic medical records (EMR) data for 1999–2010. Inclusion criteria required at least 6 months of CCR/EMR data prior to their HCV diagnosis and sufficient data post-diagnosis to calculate one or more FIB-4 scores. Primary outcome measures were time-to-death and time-to-a composite of liver-related clinical events. Cox proportional hazards models were estimated separately using three critical FIB-4 levels to define early and late viral response.
Results:
Achieving an undetectable viral load before the patient’s FIB-4 level exceed pre-specified critical values (1.00, 1.45 and 3.25) effectively reduced the risk of an adverse clinical events by 33–35% and death by 21–26%. However, achieving VLS after FIB-4 exceeds 3.25 significantly reduced the benefit of viral response.
Conclusions:
Delaying VLS until FIB-4 >3.25 reduces the benefits of VLS in reducing patient risk.
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Stubbs A, Naylor P, Ravindran K, Benjaram S, Reddy N, Mutchnick S, May E, Ehrinpreis M, Mutchnick M. Racial diversity in mortality and morbidity in urban patients with hepatitis C. J Viral Hepat 2016; 23:439-46. [PMID: 26818494 DOI: 10.1111/jvh.12504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/24/2015] [Indexed: 12/24/2022]
Abstract
Defining mortality for Caucasians and African American patients with chronic hepatitis C with respect to racial diversity is critical for counselling patients on therapy options. The objective of this study was to define racial diversity influence on mortality and morbidity of 3724 consecutive hepatitis C virus (HCV)-infected patients seen in an urban clinic between 1995 and 2008. Mortality, as of 2011, was defined using the SSA National Death Index and correlated with early visit medical information. The HCV chronically infected patient population consisted of 2879 African Americans (AA), 758 Caucasians and 87 other, and the majority were not treated for their infection prior to 2011. The average time to death from first visit was 5 years, the average age at death was 55 years, and despite racial diversity, AA were just as likely to be reported dead as Caucasians (23% AA vs 22% Caucasians). Cirrhosis and fibrosis (liver biopsy, AST Platelet Ratio Index or Fibrosis-4) at first visit as well as low albumin, diabetes, renal impairment and cardiac symptoms were associated with increased mortality. Treated patients who cleared the virus (sustained viral response (SVR); AA = 59; Caucasians = 40) had lower mortality than patients who were not treated (AA: 5% vs 27%; Caucasians 5% vs 26%). Hence, we find that race is not a factor in the early mortality of patients with chronic HCV infection and achieving a SVR reduced mortality. Unexpectedly, nonresponding AA also benefited by a lower mortality. African American patients with kidney disease and low albumin were at highest risk and should be treated as soon as identified.
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Affiliation(s)
- A Stubbs
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - P Naylor
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - K Ravindran
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - S Benjaram
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - N Reddy
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - S Mutchnick
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - E May
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - M Ehrinpreis
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - M Mutchnick
- Division of Gastroenterology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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12
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Chang ML. Metabolic alterations and hepatitis C: From bench to bedside. World J Gastroenterol 2016; 22:1461-1476. [PMID: 26819514 PMCID: PMC4721980 DOI: 10.3748/wjg.v22.i4.1461] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/14/2015] [Accepted: 10/26/2015] [Indexed: 02/06/2023] Open
Abstract
In addition to causing cirrhosis and hepatocellular carcinoma, hepatitis C virus (HCV) is thought to cause hypolipidemia, hepatic steatosis, insulin resistance, metabolic syndrome, and diabetes. The viral life cycle of HCV depends on cholesterol metabolism in host cells. HCV core protein and nonstructural protein 5A perturb crucial lipid and glucose pathways, such as the sterol regulatory element-binding protein pathway and the protein kinase B/mammalian target of rapamycin/S6 kinase 1 pathway. Although several lines of transgenic mice expressing core or full HCV proteins exhibit hepatic steatosis and/or dyslipidemia, whether they completely reflect the metabolic alterations in humans with HCV infection remains unknown. Many cross-sectional studies have demonstrated increased prevalences of metabolic alterations and cardiovascular events in patients with chronic hepatitis C (CHC); however, conflicting results exist, primarily due to unavoidable individual variations. Utilizing anti-HCV therapy, most longitudinal cohort studies of CHC patients have demonstrated the favorable effects of viral clearance in attenuating metabolic alterations and cardiovascular risks. To determine the risks of HCV-associated metabolic alterations and associated complications in patients with CHC, it is necessary to adjust for crucial confounders, such as HCV genotype and host baseline glucose metabolism, for a long follow-up period after anti-HCV treatment. Adipose tissue is an important endocrine organ due to its release of adipocytokines, which regulate lipid and glucose metabolism. However, most data on HCV infection and adipocytokine alteration are inconclusive. A comprehensive overview of HCV-associated metabolic and adipocytokine alterations, from bench to bedside, is presented in this topic highlight.
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13
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Sarkar M, Aouzierat B, Bacchetti P, Prokunina-Olsson L, French A, Seaberg E, O'Brien TR, Kuniholm MH, Minkoff H, Plankey M, Strickler HD, Peters MG. Association of IFNL3 and IFNL4 polymorphisms with liver-related mortality in a multiracial cohort of HIV/HCV-coinfected women. J Viral Hepat 2015; 22:1055-60. [PMID: 26115445 PMCID: PMC4618098 DOI: 10.1111/jvh.12431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/08/2015] [Indexed: 12/22/2022]
Abstract
African Americans coinfected with HIV and hepatitis C virus (HCV) have lower liver-related mortality than Caucasians and Hispanics. While genetic polymorphisms near the IFNL3 and IFNL4 genes explain a significant fraction of racial differences in several HCV-related outcomes, the impact of these variants on liver-related mortality has not been investigated. We conducted a cohort study of HIV/HCV-coinfected women followed in the multicentre, NIH-funded Women's Interagency HIV Study (WIHS) to investigate whether 10 polymorphisms spanning the IFN-λ region were associated with liver-related mortality by dominant, recessive or additive genetic models. We also considered whether these polymorphisms contributed to previously reported differences in liver-related death by race/ethnicity (ascertained by self-report and ancestry informative markers). Among 794 coinfected women, there were 471 deaths including 55 liver-related deaths during up to 18 years of follow-up. On adjusted analysis, rs12980275 GG genotype compared to AG+AA hazards ratios [(HR) 0.36, 95% CI 0.14-0.90, P = 0.029] and rs8109886 AA genotype compared to CC+AC (HR 0.67, 95% CI 0.45-0.99, P = 0.047) were most strongly associated with liver-related death although these associations were no longer significant after adjusting for race/ethnicity (HR 0.41, 95% CI 0.16-1.04, P = 0.060 and HR 0.78, 95% CI 0.51-1.19, P = 0.25, respectively). African American women had persistently lower liver-related death independent of IFN-λ variants (HRs ≤ 0.44, P values ≤ 0.04). The lower risk of death among African American HIV/HCV-coinfected women is not explained by genetic variation in the IFN-λ region suggesting, that other genetic, behavioural and/or environmental factors may contribute to racial/ethnic differences in liver-related mortality.
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Affiliation(s)
- M Sarkar
- Division of Gastroenterology and Hepatology, Medicine, University of California San Francisco, San Francisco, CA, USA
| | - B Aouzierat
- Nursing, University of California San Francisco, San Francisco, CA, USA
| | - P Bacchetti
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - L Prokunina-Olsson
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - A French
- Medicine, CORE Center/Stroger Hospital of Cook County, Chicago, IL, USA
| | - E Seaberg
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T R O'Brien
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - M H Kuniholm
- Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - H Minkoff
- Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - M Plankey
- Division of Infectious Diseases, Georgetown University, Washington D.C., USA
| | - H D Strickler
- Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M G Peters
- Division of Gastroenterology and Hepatology, Medicine, University of California San Francisco, San Francisco, CA, USA
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14
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Reddy N, Naylor P, Hakim Z, Asbahi R, Ravindran K, May E, Ehrinpreis M, Mutchnick M. Effect of Treatment for CHC on Liver Disease Progression and Hepatocellular Carcinoma Development in African Americans. J Clin Transl Hepatol 2015; 3:163-8. [PMID: 26623262 PMCID: PMC4663197 DOI: 10.14218/jcth.2015.00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/14/2015] [Accepted: 05/18/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS African Americans (AA) historically have a low response rate to hepatitis C therapies, and there is limited information available for this patient population regarding the development and treatment of chronic hepatitis C (CHC). The aim of this study was to evaluate liver disease progression and hepatocellular carcinoma (HCC) development in AA with CHC. METHODS Between 1995 and 2008, 246 AA patients with CHC were identified from a database of patients and followed until 2012-2013 (average 8 years) or the development of HCC after 2008. RESULTS Viral clearance (intent to treat; sustained virus response (SVR)) was achieved in 15% of patients with interferon based therapies with or without ribavirin. AA patients who achieved an SVR (n=22) did not develop HCC or new onset cirrhosis, whereas the HCC incidence in untreated AA patients was 23% (51/203). Patients who achieved an SVR also had improved fibrosis, as defined by the AST Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) score, relative to nonresponders and untreated patients. CONCLUSIONS The severity of liver disease at the first visit (except for cirrhosis) correlated with the development of HCC, but because of the overlap in values between patients, these measurements were not useful for predicting individual risk. Since cirrhosis at the first visit was not a predictive factor, treatment with newer antiviral therapies is the best option for reducing the incidence of advanced liver disease and its harmful outcomes in the AA population.
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Affiliation(s)
- Naveen Reddy
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Paul Naylor
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Zaher Hakim
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Redwan Asbahi
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Karthik Ravindran
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Elizabeth May
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Murray Ehrinpreis
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
| | - Milton Mutchnick
- Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA
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15
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Gordon SC, Lamerato LE, Rupp LB, Holmberg SD, Moorman AC, Spradling PR, Teshale E, Xu F, Boscarino JA, Vijayadeva V, Schmidt MA, Oja-Tebbe N, Lu M. Prevalence of cirrhosis in hepatitis C patients in the Chronic Hepatitis Cohort Study (CHeCS): a retrospective and prospective observational study. Am J Gastroenterol 2015; 110. [PMID: 26215529 PMCID: PMC5731242 DOI: 10.1038/ajg.2015.203] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The severity of liver disease in the hepatitis C virus (HCV)-infected population in the United States remains uncertain. We estimated the prevalence of cirrhosis in adults with chronic hepatitis C (CHC) using multiple parameters including liver biopsy, diagnosis/procedure codes, and a biomarker. METHODS Patients enrolled in the Chronic Hepatitis Cohort Study (CHeCS) who received health services during 2006-2010 were included. Cirrhosis was identified through liver biopsy reports, diagnosis/procedure codes for cirrhosis or hepatic decompensation, and Fibrosis-4 (FIB-4) scores ≥5.88. Demographic and clinical characteristics associated with cirrhosis were identified through multivariable logistic modeling. RESULTS Among 9,783 patients, 2,788 (28.5%) were cirrhotic by at least one method. Biopsy identified cirrhosis in only 661 (7%) patients, whereas FIB-4 scores and diagnosis/procedure codes for cirrhosis and hepatic decompensation identified cirrhosis in 2,194 (22%), 557 (6%), and 482 (5%) patients, respectively. Among 661 patients with biopsy-confirmed cirrhosis, only 356 (54%) had an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for cirrhosis. Older age, male gender, Asian race, Hispanic ethnicity, genotype 3 infection, HIV coinfection, diabetes, history of antiviral therapy, and history of alcohol abuse were independently associated with higher odds of cirrhosis (all, P<0.05). Conversely, private health insurance coverage, black race, and HCV genotype 2 were associated with lower odds of cirrhosis. CONCLUSIONS A high proportion of patients with biopsy-confirmed cirrhosis are not assigned ICD-9 codes for cirrhosis. Consequently, ICD-9 codes may not be reliable as the sole indicator of the prevalence of cirrhosis in cohort studies. Use of additional parameters suggests a fourfold higher prevalence of cirrhosis than is revealed by biopsy alone. These findings suggest that cirrhosis in CHC patients may be significantly underdocumented and underdiagnosed.
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Affiliation(s)
- Stuart C. Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Lois E. Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Loralee B. Rupp
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
| | - Scott D. Holmberg
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anne C. Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Philip R. Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eyasu Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fujie Xu
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph A. Boscarino
- Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA
| | - Vinutha Vijayadeva
- Center for Health Research, Kaiser Permanente-Hawaii, Honolulu, Hawaii, USA
| | - Mark A. Schmidt
- Center For Health Research, Kaiser Permanente-Northwest, Portland, Oregon, USA
| | - Nancy Oja-Tebbe
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
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16
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Hepatitis C in African Americans. Am J Gastroenterol 2014; 109:1576-84; quiz 1575, 1585. [PMID: 25178700 DOI: 10.1038/ajg.2014.243] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/01/2014] [Indexed: 12/11/2022]
Abstract
The care of hepatitis C virus (HCV) in African Americans represents an opportunity to address a major health disparity in medicine. In all facets of HCV infection, African Americans are inexplicably affected, including in the prevalence of the virus, which is higher among them compared with most of the racial and ethnic groups. Ironically, although fibrosis rates may be slow, hepatocellular carcinoma and mortality rates appear to be higher among African Americans. Sustained viral response (SVR) rates have historically significantly trailed behind Caucasians. The reasons for this gap in SVR are related to both viral and host factors. Moreover, low enrollment rates in clinical trials hamper the study of the efficacy of anti-viral therapy. Nevertheless, the gap in SVR between African Americans and Caucasians may be narrowing with the use of direct-acting agents. Gastroenterologists, hepatologists, primary care physicians, and other health-care providers need to address modifiable risk factors that affect the natural history, as well as treatment outcomes, for HCV among African Americans. Efforts need to be made to improve awareness among health-care providers to address the differences in screening and referral patterns for African Americans.
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17
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Racial differences in the progression to cirrhosis and hepatocellular carcinoma in HCV-infected veterans. Am J Gastroenterol 2014; 109:1427-35. [PMID: 25070058 DOI: 10.1038/ajg.2014.214] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/16/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The race of patients infected with hepatitis C virus (HCV) in the United States may be associated with the risk for cirrhosis and hepatocellular carcinoma (HCC). However, previous studies are too small to provide convincing data regarding the effect of race on cirrhosis and HCC risk after accounting for demographic, clinical, and virological factors. METHODS We used the Veterans Administration (VA) HCV Clinical Case Registry to identify patients with confirmed viremia between 2000 and 2009 and with at least 1 year of follow-up in the VA. We identified cirrhosis and HCC cases through early 2010. Cox proportional hazard regression models were performed to examine the effect of race on the risk for cirrhosis and HCC while adjusting for patients' age, gender, period of service (World War I/II, Vietnam era, post-Vietnam era), HIV coinfection, HBV coinfection, alcohol abuse, diabetes, body mass index, and antiviral treatment receipt and response. RESULTS There were 149,407 patients with active HCV viremia. Of them, 56.3% were non-Hispanic White (NHW), 36.1% were African American (AA), 6.0% were Hispanic, and 1.6% belonged to other racial groups. After an average follow-up of 5.2 years, 13,099 patients were seen to have a recorded diagnosis of cirrhosis and 3,551 had HCC. Hispanics had the highest annual incidence rates of cirrhosis and HCC (28.8 and 7.8%, respectively), whereas AAs had the lowest rates (13.3% and 3.9%, respectively) compared with NHWs (21.6 and 4.7%, respectively). There were differences among NHW, AA, and Hispanic patients in the rates of HIV infection (2.1, 2.5, and 6.0%, respectively), HCV genotype 1 (50.0, 50.6, and 64.2%, respectively), obesity (28.0, 25.4, and 30.9%, respectively), diabetes (8.7, 16.1, and 16.1%, respectively), and absence of antiviral treatment (81.1, 89.6, and 82.1%, respectively). However, adjusting for differences in demographic and clinical factors did not change the magnitude or direction of the race effect. Compared with NHWs, Hispanic patients had a higher risk of having cirrhosis recorded (adjusted hazard ratio (HR)=1.28, 95% confidence interval (CI)=1.21-1.37) and HCC (1.61, 95% CI=1.44-1.80). In contrast, AAs had a lower risk of cirrhosis (HR=0.58, 95% CI=0.55-0.60) and HCC (0.77, 95% CI=0.71-0.83) compared with NHWs. CONCLUSIONS Hispanics with HCV are at a significantly higher risk, whereas AAs are at a considerably lower risk of developing cirrhosis and HCC than are NHWs. These associations persisted even after adjusting for a range of factors including HCV genotype, HCV treatment, diabetes, and body mass index.
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18
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Lisker-Melman M, Walewski JL. The impact of ethnicity on hepatitis C virus treatment decisions and outcomes. Dig Dis Sci 2013; 58:621-9. [PMID: 23065087 DOI: 10.1007/s10620-012-2392-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 08/28/2012] [Indexed: 12/17/2022]
Abstract
Hepatitis C virus infection is a major public health concern. Approximately 4 million people are reported to be infected with the virus in the United States, and the annual death rate due to HCV-associated decompensated liver failure or hepatocellular carcinoma is estimated to be approximately 18,000 within the next decade. Therapeutic success, as measured by a sustained virologic response, is approximately 50 % in G1 patients with pegylated-interferon/ribavirin-based therapies. Independent studies have reported significant variation in response rates depending on the ethnicity or race of the patient, though the underlying reasons are not well understood. Historically, ethnic populations have been underrepresented in most large clinical trials of HCV therapies, even though these populations have disproportionately high rates of HCV infection. Recent clinical trials have investigated genetic variations in key biological pathways that may underlie the mechanisms responsible for the different rates of HCV clearance and treatment outcomes in ethnic populations treated with pegylated-interferon/ribavirin. However, as novel direct-acting antiviral drugs are added to, and eventually replace, existing treatment regimens, the role of the innate immune response in determining treatment outcomes will diminish. Socioeconomic and biological factors can impact rates of HCV infection, disease progression, and treatment outcomes in minority populations. Improved access to health care, novel antiviral treatments, and a better understanding of the host factors that contribute to disparities in treatment outcomes are expected to result in optimized treatment paradigms that directly target the virus, leading to improved outcomes for all patients.
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Affiliation(s)
- Mauricio Lisker-Melman
- Hepatology Program, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA.
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19
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Marcellin P, Gane E, Buti M, Afdhal N, Sievert W, Jacobson IM, Washington MK, Germanidis G, Flaherty JF, Aguilar Schall R, Bornstein JD, Kitrinos KM, Subramanian GM, McHutchison JG, Heathcote EJ. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet 2013; 381:468-75. [PMID: 23234725 DOI: 10.1016/s0140-6736(12)61425-1] [Citation(s) in RCA: 1264] [Impact Index Per Article: 114.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Whether long-term suppression of replication of hepatitis B virus (HBV) has any beneficial effect on regression of advanced liver fibrosis associated with chronic HBV infection remains unclear. We aimed to assess the effects on fibrosis and cirrhosis of at least 5 years' treatment with tenofovir disoproxil fumarate (DF) in chronic HBV infection. METHODS After 48 weeks of randomised double-blind comparison (trials NCT00117676 and NCT00116805) of tenofovir DF with adefovir dipivoxil, participants (positive or negative for HBeAg) were eligible to enter a 7-year study of open-label tenofovir DF treatment, with a pre-specified repeat liver biopsy at week 240. We assessed histological improvement (≥2 point reduction in Knodell necroinflammatory score with no worsening of fibrosis) and regression of fibrosis (≥1 unit decrease by Ishak scoring system). FINDINGS Of 641 patients who received randomised treatment, 585 (91%) entered the open-label phase, and 489 (76%) completed 240 weeks. 348 patients (54%) had biopsy results at both baseline and week 240. 304 (87%) of the 348 had histological improvement, and 176 (51%) had regression of fibrosis at week 240 (p<0·0001). Of the 96 (28%) patients with cirrhosis (Ishak score 5 or 6) at baseline, 71 (74%) no longer had cirrhosis (≥1 unit decrease in score), whereas three of 252 patients without cirrhosis at baseline progressed to cirrhosis at year 5 (p<0·0001). Virological breakthrough occurred infrequently and was not due to resistance to tenofovir DF. The safety profile was favourable: 91 (16%) patients had adverse events but only nine patients had serious events related to the study drug. INTERPRETATION In patients with chronic HBV infection, up to 5 years of treatment with tenofovir DF was safe and effective. Long-term suppression of HBV can lead to regression of fibrosis and cirrhosis. FUNDING Gilead Sciences.
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Affiliation(s)
- Patrick Marcellin
- Service d'Hépatologie, Hôpital Beaujon, INSERM Unit CRB3, Clichy, France.
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20
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Uemura T, Nikkel LE, Hollenbeak CS, Ramprasad V, Schaefer E, Kadry Z. How can we utilize livers from advanced aged donors for liver transplantation for hepatitis C? Transpl Int 2012; 25:671-9. [DOI: 10.1111/j.1432-2277.2012.01474.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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21
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Verna EC, Valadao R, Farrand E, Pichardo EM, Lai JC, Terrault NA, Brown RS. Effects of ethnicity and socioeconomic status on survival and severity of fibrosis in liver transplant recipients with hepatitis C virus. Liver Transpl 2012; 18:461-7. [PMID: 22467547 PMCID: PMC3674870 DOI: 10.1002/lt.23376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The ethnicity and socioeconomic status of the host may affect the progression of hepatitis C virus (HCV). We aimed to compare survival and fibrosis progression in Hispanic white (HW) and non-Hispanic white (NHW) recipients of liver transplantation (LT) with HCV. All HW and NHW patients with HCV who underwent transplantation between January 2000 and December 2007 at 2 centers were retrospectively assessed. The primary outcomes were the time to death, death or graft loss due to HCV, and significant fibrosis [at least stage 2 of 4]. Five hundred eleven patients were studied (159 HW patients and 352 NHW patients), and the baseline demographics were similar for the 2 groups. NHW patients were more likely to be male, to have attended college, and to have private insurance, and they had a higher median household income (MHI). The unadjusted rates of survival (log-rank P = 0.93), death or graft loss due to HCV (P = 0.89), and significant fibrosis (P = 0.95) were similar between groups. In a multivariate analysis controlling for center, age [hazard ratio (HR) per 10 years = 1.43, P = 0.01], donor age (HR per 10 years = 1.25, P < 0.001), and rejection (HR = 1.47, P = 0.048) predicted death, whereas HW ethnicity (HR = 1.06, P = 0.77) was not significant. Independent predictors of significant fibrosis were HW ethnicity (HR = 2.42, P = 0.046), MHI (HR per $10,000 = 1.11, P = 0.01), donor age (HR per 10 years = 1.13, P = 0.02), cold ischemia time (HR = 1.06, P = 0.03), and the interaction between ethnicity and MHI (HR = 0.82, P = 0.03). In conclusion, there is no difference in post-LT survival or graft loss due to HCV between HW patients and NHW patients. Socioeconomic factors may influence disease severity; this is suggested by our findings of more significant fibrosis in HW patients with a low MHI.
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Affiliation(s)
- Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY
| | - Rosa Valadao
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Erica Farrand
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY
| | - Elsa M. Pichardo
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY
| | - Jennifer C. Lai
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Norah A. Terrault
- Department of Medicine, University of California San Francisco, San Francisco, CA
,Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Robert S. Brown
- Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY
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Chronic liver disease in the Hispanic population of the United States. Clin Gastroenterol Hepatol 2011; 9:834-41; quiz e109-10. [PMID: 21628000 PMCID: PMC4184097 DOI: 10.1016/j.cgh.2011.04.027] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 04/01/2011] [Accepted: 04/28/2011] [Indexed: 02/07/2023]
Abstract
Chronic liver disease is a major cause of morbidity and mortality among Hispanic people living in the United States. Environmental, genetic, and behavioral factors, as well as socioeconomic and health care disparities among this ethnic group have emerged as important public health concerns. We review the epidemiology, natural history, and response to therapy of chronic liver disease in Hispanic patients. The review covers nonalcoholic fatty liver disease, viral hepatitis B and C, coinfection of viral hepatitis with human immunodeficiency virus, alcoholic cirrhosis, hepatocellular carcinoma, autoimmune hepatitis, and primary biliary cirrhosis. For most of these disorders, the Hispanic population has a higher incidence and more aggressive pattern of disease and overall worse treatment outcomes than in the non-Hispanic white population. Clinicians should be aware of these differences in caring for Hispanic patients with chronic liver disease.
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23
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White DL, Richardson PA, Al-Saadi M, Fitzgerald SJ, Green L, Amaratunge C, Manvir A, El-Serag HB. Dietary history and physical activity and risk of advanced liver disease in veterans with chronic hepatitis C infection. Dig Dis Sci 2011; 56:1835-47. [PMID: 21188525 PMCID: PMC3383839 DOI: 10.1007/s10620-010-1505-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 11/17/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of customary diet and physical activity in development of advanced HCV-related liver disease is not well-established. METHODS We conducted a retrospective association study in 91 male veterans with PCR-confirmed chronic HCV and biopsy-determined hepatic pathology. Respondents completed the Block Food Frequency and the International Physical Activity questionnaires. We conducted three independent assessments based on hepatic pathology: fibrosis (advanced = F3-F4 vs. mild = F1-F2), inflammation (advanced = A2-A3 vs. mild = A1) and steatosis (advanced = S2-S3 vs. mild = S1). Each assessment compared estimated dietary intake and physical activity in veterans with advanced disease to that in analogous veterans with mild disease. Multivariate models adjusted for total calories, age, race/ethnicity, biopsy-to-survey lag-time, BMI, pack-years smoking, and current alcohol use. RESULTS Average veteran age was 52, with 48% African-American. Advanced fibrosis was more prevalent than advanced inflammation or steatosis (52.7% vs. 29.7% vs. 26.4%, respectively). The strongest multivariate association was the suggestive 14-fold significantly decreased advanced fibrosis risk with lowest dietary copper intake (OR = 0.07, 95% CI 0.01-0.60). Other suggestive associations included the 6.5-fold significantly increased advanced inflammation risk with lower vitamin E intake and 6.2-fold significantly increased advanced steatosis risk with lower riboflavin intake. The only physical activity associated with degree of hepatic pathology was a two-fold greater weekly MET-minutes walking in veterans with mild compared to advanced steatosis (P = 0.02). CONCLUSIONS Several dietary factors and walking may be associated with risk of advanced HCV-related liver disease in male veterans. However, given our modest sample size, our findings must be considered as provisional pending verification in larger prospective studies.
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Affiliation(s)
- Donna L. White
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021,Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2002 Holcombe Blvd, Houston, Texas 77030,Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Peter A. Richardson
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Mukhtar Al-Saadi
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021,Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Stephanie J. Fitzgerald
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021,Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Linda Green
- Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Chami Amaratunge
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2002 Holcombe Blvd, Houston, Texas 77030
| | - Anand Manvir
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021,Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
| | - Hashem B. El-Serag
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021,Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2002 Holcombe Blvd, Houston, Texas 77030,Clinical Epidemiology and Outcomes Program, Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, 2450 Holcombe Blvd (01Y), Houston, Texas 77021
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Fontana RJ, Sanyal AJ, Ghany MG, Bonkovsky HL, Morgan TR, Litman HJ, Reid AE, Lee WM, Naishadham D. Development and progression of portal hypertensive gastropathy in patients with chronic hepatitis C. Am J Gastroenterol 2011; 106:884-93. [PMID: 21139575 PMCID: PMC3772514 DOI: 10.1038/ajg.2010.456] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The objective of this study was to determine the incidence and risk factors associated with new-onset and worsening portal hypertensive gastropathy (PHG) in patients with chronic hepatitis C (CHC). METHODS A total of 831 CHC patients with bridging fibrosis or cirrhosis at the time of entry were prospectively monitored for clinical and histological liver disease progression while receiving either low-dose peginterferon α2a or no antiviral therapy in the HALT-C (Hepatitis C Antiviral Long-term Treatment against Cirrhosis) trial. Upper endoscopy with grading of PHG was performed at baseline and at year 4 of the study. The presence and severity of PHG were determined using the NIEC (New Italian Endoscopy Conference) criteria, and worsening PHG was defined as a score increase of ≥1 point. RESULTS During a median follow-up of 3.85 years, 50% of 514 subjects without PHG developed new-onset PHG, whereas 26% of 317 patients with baseline PHG had worsening PHG. Independent predictors of new-onset PHG included higher alkaline phosphatase and being diabetic, whereas predictors of worsening PHG were Caucasian race, lower albumin, as well as higher serum aspartate transaminase/alanine transaminase ratio and homeostatic model assessment levels. New-onset and worsening PHG were significantly associated with clinical and histological progression. They were also associated with new-onset and worsening gastroesophageal varices. CONCLUSIONS New-onset and worsening PHG develop at a rate of 12.9% per year and 6.7% per year, respectively, in non-responder CHC patients with advanced fibrosis. If confirmed in other studies, endoscopic surveillance for PHG may need to be tailored to individual patient risk factors.
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Affiliation(s)
- Robert J. Fontana
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Arun J. Sanyal
- Division of Gastroenterology, Department of Internal Medicine, Virginia commonwealth University Medical Center, Richmond, VA
| | - Marc G. Ghany
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Herbert L. Bonkovsky
- Department of Medicine, University of Connecticut Health Center, Farmington, CT
,Carolinas Medical Center, Charlotte, NC
| | - Timothy R. Morgan
- Division of Gastroenterology, University of California – Irvine, Irvine, CA
,Gastroenterology Service, VA Long Beach Healthcare system, Long Beach, CA
| | | | - Andrea E. Reid
- Gastrointestinal Unit (Medical Services), Massachusetts General Hospital, Boston, MA
| | - William M. Lee
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX
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Comparcola D, Alisi A, Nobili V. Hepatitis C virus and nonalcoholic Fatty liver disease: similar risk factors for necroinflammation, fibrosis, and cirrhosis. Clin Gastroenterol Hepatol 2010; 8:97; author reply 97. [PMID: 19772950 DOI: 10.1016/j.cgh.2009.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 09/06/2009] [Indexed: 02/07/2023]
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