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Racial disparity in age and genotype defines urban hepatitis C patient profiles in the recent direct-acting antiviral era


Gastroenterology & Hepatology: Open Access
Ria Minawala BS, Katherine Wong, Paul Naylor, Murray Ehrinpreis, Milton Mutchnick

Abstract

Introduction:  Hepatitis C virus (HCV) infections are a national health issue despite highly effective therapy and screening of the high prevalence age cohort. Since an increase in younger patients may be occurring, we evaluated HCV patients seen in our urban clinic for their demographics and treatment history.

Methods:EMR charts of all 601 patients with a diagnosis of HCV seen in Wayne Health Clinics in 2019 were reviewed.

Results:The HCV patients were predominantly African American (AA) (85%) with most yet to be treated (73%). AA patients were older than non-AA patients (63 vs 51years), had a greater likelihood of HCV genotype 1 (94% vs 60%) and had lower ALT values. Patients were seen and treated by both Gastroenterology (73%) and Infectious Disease (27%) physicians and SVR rates were greater than 95%. Fibrosis, as determined by serological biomarkers, was improved in AA patients who had achieved viral clearance (SVR) as compared to those who were untreated.

Conclusions:  AA patients were older and more likely to have genotype 1, and with less inflammation (ALT) as compared to Non-AA patients. The data confirms the continuing need to ensure linkage to all HCV patients to prevent additional HCV transmission and future liver disease manifestation. While fibrosis in our population correlates with age, there was a significant number of older AA patients with minimal fibrosis. Further evaluation of these patients may reveal a more recent acquisition versus a slower development of fibrosis over time.

Keywords

racial disparity, African Americans, hepatitis c, direct acting anti-virals, linkage to care, age disparity

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