—Christine. M. Kukka, Project Manager, HBV Advocate
Which racial/ethnic group in the United States
highest rate of
hepatitis B infections in 2010?
assume Asian-Americans who have high chronic infection rates had
distinction, but think of another racial group facing similar
economic barriers to health care—African-Americans.
According to a study by University of
researchers, African-Americans make up the largest percentage of
people who are
newly infected with hepatitis B today.
In 2010, African-Americans had the highest rate
of acute HBV
infection with 1.7 cases per 100,000 people. In contrast,
an acute infection rate of 0.6 per 100,000. Asian-Americans may
have a higher
rate of chronic infection due to infection at birth, but most of
infections occurring in the United States today happen to
In America, being black means you have a
3.9-fold chance of
being infected with hepatitis B, compared to whites.
According to the study, published in the August
issue of the Journal of Clinical Gastroenterology and Hepatology,
African-Americans tend to
be infected with HBV genotype
A (84%), which is associated with a 4-
to 5-fold increase in liver cancer compared to other
genotypes. In contrast, Asian-Americans are often infected with
less virulent genotypes B and C.
matters worse, the few hepatitis B studies that have been
African-Americans and immigrants from Africa found that liver
cancer occurs at
a younger age in these populations than in other ethnic groups. African-Americans
may have genetic risk factors that predispose them to
developing chronic hepatitis B following exposure to the virus
ethnic groups do not face. Yet, few doctors know to screen their
African-American clients for hepatitis B.
If little is known about the progression of
liver disease in
HBV-infected African-Americans, even less is known about the
follow-up study of
patients treated with interferon found that African American
"... much more likely to respond to therapy," researchers wrote.
"Of note, all African American responders not only cleared the
"e" antigen and (achieved undetectable) HBV DNA ... but all
HBsAg, a relatively rare milestone with HBV therapy that
(usually) occurs in
(only) 7.8% of patients on therapy."
was a small
study and no additional research into African-Americans'
remarkable ability to
reportedly clear hepatitis B infection after interferon
treatment has been
repeated to verify these results.
When it comes to
of antivirals in African-Americans, few clinical trials have
impact in this population. "...There are inadequate data about
efficacy and safety of these agents in African American patients
HBV infection," researchers added.
As with Asian-Americans, few African-Americans
for treatment ever receive it. A small study that included
patients from an
urban medical center found that only 7% of a predominantly
Hispanic population had been initiated on therapy.
The study cited lack of health insurance,
failure to take
medication as prescribed and ongoing drug and alcohol use as
for poor access to treatment. Not surprising, access to liver
also far lower among African-Americans than whites.
"Continued research is needed to identify and
areas of disparity in chronic HBV infection and treatment, and an
in enrollment of African Americans in clinical trials is essential
achievement of this goal," the researchers noted.
B and C
Americans: Current Status and Continued Challenges
Gastroenterology and Hepatology, Department of Medicine,
Perelman School of
Medicine, University of Pennsylvania, Philadelphia,
Pennsylvania; Center for
Clinical Epidemiology and Biostatistics, Department of
Epidemiology, Perelman School of Medicine, University of
remains a public health concern in the United States, resulting
morbidity and mortality for the individual and representing a
societies as evidenced by billions of dollars in healthcare
with many chronic diseases, race and ethnicity influence various
disease pathogenesis including mechanisms of persistence,
disease sequelae, and response to therapy. For hepatitis
B and C infections, African Americans
disproportionately bear a large
burden of disease in the United States. The role and importance
American race, however, have been less well characterized in the
among the population of viral hepatitis-infected individuals.
in epidemiology, manifestations of liver disease, response to
differential trends in liver transplantation in African
Americans compared with
other racial and ethnic groups deserve special attention. This
address the current status of hepatitis
B and C
infection in African Americans in the United States and identify
some of the
remaining challenges in diagnosis, characterization of natural
For purposes of this review, the terms African
American and black
will be used interchangeably throughout the text.
Labels: African-Americans, Blacks, disparities, epidemiology