—Christine. M. Kukka, Project Manager, HBV Advocate
Which racial/ethnic group in the United States
had the
highest rate of
acute (new)
hepatitis B infections in 2010?
You
might
assume Asian-Americans who have high chronic infection rates had
this
distinction, but think of another racial group facing similar
cultural and
economic barriers to health care—African-Americans.
According to a study by University of
Pennsylvania
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,
Asian-Americans had
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
the new
infections occurring in the United States today happen to
African-Americans.
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.
To make
matters worse, the few hepatitis B studies that have been
performed in
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
that other
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
effectiveness of
treatment.
A long-term
follow-up study of
patients treated with interferon found that African American
patients were,
"... much more likely to respond to therapy," researchers wrote.
"Of note, all African American responders not only cleared the
hepatitis B
"e" antigen and (achieved undetectable) HBV DNA ... but all
cleared
HBsAg, a relatively rare milestone with HBV therapy that
(usually) occurs in
(only) 7.8% of patients on therapy."
Unfortunately, this
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
the effectiveness
of antivirals in African-Americans, few clinical trials have
examined their
impact in this population. "...There are inadequate data about
the
efficacy and safety of these agents in African American patients
with chronic
HBV infection," researchers added.
As with Asian-Americans, few African-Americans
who qualify
for treatment ever receive it. A small study that included
patients from an
urban medical center found that only 7% of a predominantly
African-American and
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
possible reasons
for poor access to treatment. Not surprising, access to liver
transplants was
also far lower among African-Americans than whites.
"Continued research is needed to identify and
address
areas of disparity in chronic HBV infection and treatment, and an
improvement
in enrollment of African Americans in clinical trials is essential
for
achievement of this goal," the researchers noted.
Abstract:Hepatitis
B and C
in African
Americans: Current Status and Continued Challenges
Forde
KA, Tanapanpanit
O, Reddy
KR.
Division
of
Gastroenterology and Hepatology, Department of Medicine,
Perelman School of
Medicine, University of Pennsylvania, Philadelphia,
Pennsylvania; Center for
Clinical Epidemiology and Biostatistics, Department of
Biostatistics and
Epidemiology, Perelman School of Medicine, University of
Pennsylvania,
Philadelphia, Pennsylvania.
Viral
hepatitis
remains a public health concern in the United States, resulting
in excess
morbidity and mortality for the individual and representing a
burden to
societies as evidenced by billions of dollars in healthcare
expenditures.
As
with many chronic diseases, race and ethnicity influence various
aspects of
disease pathogenesis including mechanisms of persistence,
disease progression,
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
of African
American race, however, have been less well characterized in the
literature
among the population of viral hepatitis-infected individuals.
The differences
in epidemiology, manifestations of liver disease, response to
therapy, and
differential trends in liver transplantation in African
Americans compared with
other racial and ethnic groups deserve special attention. This
review will
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
history, and
treatment.
For purposes of this review, the terms African
American and black
will be used interchangeably throughout the text.
Labels: African-Americans, Blacks, disparities, epidemiology