Hepatitis C infection in African Americans: Its natural history and histological progression

OBJECTIVE: The aim of this retrospective analysis was to determine the natural history of hepatitis C virus infection in African Americans versus non-African Americans by evaluating the clinical, virological, and histological findings. METHODS: We examined in a retrospective manner the demographics, mode of infection, virological features, and histological progression of HCV infection in African Americans versus non-African Americans. There were 355 patients who met criteria based on adequate liver biopsy specimens and exclusion of other hepatic diseases. RESULTS: African Americans (n = 112) were significantly more likely to be infected with genotype 1 virus (88%) than were non-African Americans (n = 243; 67%; p less than or equal to 0.001). Baseline HCV RNA levels were similar, although baseline ALT Values were significantly lower in African Americans (80.0 mul +/- 5.5 vs 112.1 mul 6.2; p less than or equal to 0.001). African Americans were significantly older at the time of presentation and were significantly more likely to be women (p less than or equal to 0.02). In African Americans, there was a trend toward less cirrhosis (22% vs 30%; p less than or equal to 0.1) and significantly less piecemeal necrosis on liver biopsy. Non-African Americans had significantly higher fibrosis scores, ALT values, and piecemeal necrosis ratings, and tended to progress more rapidly to cirrhosis. This difference in histological progression between the two groups was not explained by differences in alcohol consumption. CONCLUSION: The lower ALT, piecemeal necrosis scores, and slower progression of fibrosis in African Americans may reflect less immunological recognition of HCV-infected liver cells. (Am J Gastroenterol. 2002;97:700-706. (C) 2002 by Am. Coll. of Gastroenterology).