Chronic hepatitis C in Latinos:: Natural history, treatment eligibility, acceptance, and outcomes
Chronic hepatitis C in Latinos:: Natural history, treatment eligibility, acceptance, and outcomes
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DOI：
10.1111/j.1572-0241.2005.00240.x
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发表时间：
2005-10-01
影响因子：
9.8
通讯作者：
Wright, TL
中科院分区：
文献类型：
--
作者：
Cheung, RC;Currie, S;Wright, TL
目的：在黑人和高加索人中，慢性丙型肝炎的自然病史和治疗反应是不同的，但关于拉丁裔的可比性数据很少。方法：一项横断面二次分析调查了24个VA医学中心的421名抗-丙型肝炎病毒阳性、治疗初学者、丙型肝炎病毒携带者拉丁裔和2510名高加索人之间的差异。结果：拉美裔人感染年龄更小，在战斗、手术和针刺伤中接触血液的可能性较小，但HIV合并感染的频率更高(20.4%vs3.9%，p<；0.0001)和既往甲型肝炎病毒感染者(39.9%比26.4%，p=0.0001)。拉丁裔更有可能成为治疗候选者，但不太可能真正开始治疗。肝脏组织学(123个拉丁裔，743个高加索人)在纤维化或纤维化率方面没有差异，但脂肪变性(54.7%比43.2%，p=0.038)在拉丁裔中更常见。88名拉丁裔和481名高加索人随后接受了干扰素-利巴韦林治疗：体重指数(BMI)、感染持续时间、基线测试、肝脏组织学和基因分布相似。与高加索人相比，拉丁美洲人过早停止治疗的频率更高(39.8%比28.9%，p=0.043)，持续病毒学应答率更低(14.8%比22.5%，p=0.10)。多因素分析发现，拉丁裔种族和最近饮酒史与早期停止治疗有关，而基因型和病毒载量而不是种族与SVR有关。结论：拉丁裔感染较年轻，更频繁地合并感染HIV，更有可能满足抗病毒治疗的标准，但启动治疗的可能性较小，并且有比高加索人更低的SVR率的趋势，但肝病的严重性没有变化。拉丁裔种族与早期停药有关，但不是SVR的独立预测因素。
OBJECTIVES: The natural history of chronic hepatitis C and treatment response are different between blacks and Caucasians, but little comparable data is available about Latinos.METHODS: A cross-sectional secondary analysis to investigate differences between 421 anti-HCV-positive, treatment-naive, HCV-viremic Latinos and 2,510 Caucasians in 24 VA medical centers enrolled in a prospective study.RESULTS: Latinos were infected at a younger age and were less likely to have blood contact during combat, surgery, and needle stick injury, but were more frequently HIV coinfected (20.4%vs 3.9%, p < 0.0001) and prior HAV infection (39.9%vs 26.4%, p= 0.0001). Latinos were more likely to be treatment candidates, but less likely to actually initiate treatment. Liver histology (123 Latinos, 743 Caucasians) showed no difference in fibrosis or fibrosis rate, but steatosis (54.7%vs 43.2%, p= 0.038) was more common in Latinos. Eighty-eight Latinos and 481 Caucasians were subsequently treated with interferon-ribavirin: body mass index (BMI), duration of infection, baseline tests, liver histology and genotype distribution were similar. Compared with Caucasians, Latinos discontinued treatment prematurely more often (39.8%vs 28.9%, p= 0.043) and tended to have lower sustained virological response (SVR) rates (14.8%vs 22.5%, p= 0.10). Multivariate analysis found Latino race and history of recent alcohol use to be associated with early treatment discontinuation, whereas genotype and viral load but not ethnicity to be associated with SVR.CONCLUSIONS: Latinos were infected younger, more frequently HIV coinfected, more likely to meet criteria for antiviral therapy yet less likely to initiate treatment and had a trend toward lower SVR rates than Caucasians, but not in severity of liver disease. Latino ethnicity was associated with early discontinuation but not as an independent predictor of SVR.