title: Fibrosis progression in African Americans and Caucasian Americans with chronic hepatitis C.
abstract: OBJECTIVE
  Prior studies suggest the rate of liver fibrosis progression is slower in African Americans (AAs) than Caucasian Americans (CAs) with chronic HCV infection.
  
  
  METHODS
  With a multi-state Markov model, fibrosis progression was evaluated in a well-characterized cohort of 143 AA and 157 CA adults with untreated chronic HCV genotype 1 infection. In subjects with a history of injection drug use, duration of infection was imputed from a fitted risk model rather than assumed to be the reported first year of use.
  
  
  RESULTS
  The distribution of Ishak fibrosis stages was 0 (8.7%), 1/2 (55.7%), 3/4 (29.3%), and 5/6 (6.3%) and was similar in AAs and CAs (P = .22). After adjusting for biopsy adequacy, AAs had a 10% lower rate of fibrosis progression than did CAs, but the difference was not statistically significant (hazard ratio, 0.90; 95% confidence interval, 0.72-1.12). The overall 20-year estimates of probabilities of progression from stage 0 to stages 1/2, 3/4, and 5/6 were 59.3%, 28.8%, and 4.7%, respectively. The estimated median time from no fibrosis to cirrhosis was 79 years for the entire cohort and 74 and 83 years for CAs and AAs, respectively. In 3-variable models including race and biopsy adequacy, the factors significantly associated with fibrosis progression were age when infected, steatosis, ALT level, and necroinflammatory score.
  
  
  CONCLUSIONS
  The rates of fibrosis progression were slow and did not appear to differ substantially between AAs and CAs.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California 94143-0538, USA. norah.terrault@ucsf.edu
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
authors.forename: Kelly
authors.initials: K
authors.lastname: Im
authors.forename: Ross
authors.initials: R
authors.lastname: Boylan
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: David E
authors.initials: DE
authors.lastname: Kleiner
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.forename: Jay H
authors.initials: JH
authors.lastname: Hoofnagle
authors.forename: Steven H
authors.initials: SH
authors.lastname: Belle
mesh_terms: D000328:Adult; D001741:Black or African American; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States; D044465:White People