Ethnic disparities evaporate with DAA treatment of hepatitis C infections

Early diagnosis and treatment of hepatitis C virus (HCV) infections can prevent liver cancer and end-stage liver disease even in high-risk ethnic minorities, according to a new study. 

There is a well-known ethnic disparity in the U.S. among HCV patients, with a higher risk of cancer, cirrhosis and long-term outcomes among Hispanic and Asian patients as compared to Caucasians. In the interferon era, studies showed Asians had the lowest rate of treatment, and African Americans and Hispanics were also less likely to receive care than Caucasians.

“Untreated Asian and Hispanics infected with HCV have a higher risk, but the good news is when they are treated with direct-acting antiviral (DAA) agents and respond, they get the same cure as Caucasians,” senior author Mindie Nguyen, MD, professor of medicine at Stanford University Medical Center in Palo Alto, CA, told Medical Economics. “If we get these people into treatment, we eliminate the higher risk and medical disparities. This should be a huge encouragement to patients and doctors to link ethnic minorities to therapy. They will do just as well as the rest of the population.”

The researchers published their results in September 2017 Alimentary Pharmacology & Therapeutics.

Nguyen and colleagues conducted a cohort study of 8,039 consecutive adult chronic HCV patients seen at two medical centers in California between January 1997 and June 2016. On multivariate analysis, Hispanic ethnicity was independently associated with increased cirrhosis (adjusted HR 1.37) and hepatocellular carcinoma (HCC) risk (adjusted HR 1.47) as compared to Caucasians. Asian ethnicity also had a significant association with cirrhosis (adjusted HR 1.28) and HCC risk (adjusted HR 1.29).

After DAA treatment, Hispanic or Asian ethnicity was no longer independently associated with cirrhosis or HCC, among patients who achieved sustained virologic response (SVR). Some patients developed cirrhosis and HCC following SVR. Nguyen suggested continued regular follow-up and HCC surveillance for chronic HCV patients with advanced fibrosis or cirrhosis even after successful SVR.

By screening patients at risk, primary care physicians can be enlisted to address economic and insurance barriers faced by ethnic minorities that result in poorer access to care. This includes all U.S.-born patients between the age of 45 to 65 as well as those with high-risk behaviors. “Primary care physicians need to screen every patient in this birth cohort and those from endemic areas,” she said.

Hepatologists are well-tuned to the successes of DAA treatment of HCV, but some community physicians may not be. “DAA treatment is well tolerated, but the treatment duration can be difficult if the patient has cirrhosis, which can be difficult to determine. Many primary care physicians may not feel comfortable about evaluating cirrhosis and may need to send HCV-infected patients to specialists,” said Nguyen. She recommended that primary care physicians locate a liver center with specialists who can handle complex cases.

“If you feel comfortable, treat the patient yourself. If you don’t, or lack the ability to evaluate duration of cirrhosis, then refer to a specialist. The earlier HCV patients are diagnosed and treated will prevent future severe complications,” said Nguyen.