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African Americans Are Less Likely to Have Clearance of Hepatitis C Virus Infection: The Findings from Recent U.S. Population Data

Mir, Heshaam M. MD*,†; Stepanova, Maria PhD*,†; Afendy, Mariam BS*,†; Kugelmas, Marcelo MD; Younossi, Zobair M. MD, MPH*,†

Journal of Clinical Gastroenterology: September 2012 - Volume 46 - Issue 8 - p e62–e65
doi: 10.1097/MCG.0b013e318238352b
ONLINE ARTICLES: Original Articles

Background: Hepatitis C virus (HCV) is the most common cause of chronic liver disease in the United States. African Americans are known to have a higher prevalence of HCV and lower response to anti-HCV therapy.

GOAL: The aim of this study is to assess the differences in the prevalence of chronic HCV infection in according to patients’ ethnic background.

Study: We used the recent National Health and Nutrition Examination Survey with extensive clinical and laboratory data. Active HCV infection was defined as having HCV-positive antibody with detectable HCV RNA by polymerase chain reaction. HCV clearance was defined as HCV-positive antibody with negative HCV RNA. Clinico-demographic data were compared between anti-HCV positive individuals with or without HCV clearance. The stratum-specific χ2 test for independence was used. Logistic regression was used to identify independent predictors of HCV clearance. P-values ≤0.05 were considered statistically significant. All analyses were run using SAS 9.1 and SUDAAN 10.0.

Results: The cohort included 14,750 adults (age 47.6±0.75 y, 64% white, 21% African American, 10% Hispanics, and 63% male). Of these, 1.32±0.11% were anti-HCV positive with 75.94±4.72% having active HCV viremia. The only parameter significantly different between those who did or did not clear HCV was the proportion of African Americans: 8.0±3.7% versus 24.9±5.0%, P=0.0163. Indeed, the rate of HCV clearance was lowest among African Americans (9.3±3.5%) as compared with both whites (27.2±6.5%) and Hispanics 31.2±9.1% (P<0.05). In multivariate analysis, the only independent predictor of active HCV infection was African American race: odds ratio (95% confidence interval)=3.80 (1.31-11.06), P=0.0151.

Conclusions African Americans not only have lower response to anti-HCV therapy but also are less likely to naturally clear HCV, potentially contributing to higher prevalence of HCV.

*Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital

Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA

South Denver Gastroenterology PC, Denver, CO

This work was supported by the Liver Disease Outcomes Research Fund of the Center for Liver Diseases at Inova Fairfax Hospital, Inova Health System.

The authors declare that they have nothing to disclose.

Reprints: Zobair M. Younossi, MD, MPH, Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA 22042 (e-mail:

Received August 3, 2011

Accepted September 16, 2011

© 2012 Lippincott Williams & Wilkins, Inc.