title: Racial differences in hepatitis C treatment eligibility.
abstract: Black Americans are disproportionally infected with hepatitis C virus (HCV) and are less likely than whites to respond to treatment with peginterferon (PEG-IFN) plus ribavirin (RBV). The impact of race on HCV treatment eligibility is unknown. We therefore performed a retrospective analysis of a phase 3B multicenter clinical trial conducted at 118 United States community and academic medical centers to evaluate the rates of and reasons for HCV treatment ineligibility according to self-reported race. In all, 4,469 patients were screened, of whom 1,038 (23.2%) were treatment ineligible. Although blacks represented 19% of treated patients, they were more likely not to be treated due to ineligibility and/or failure to complete required evaluations (40.2%) than were nonblack patients (28.5%; P < 0.001). After the exclusion of persons not treated due to undetectable HCV RNA or nongenotype 1 infection, blacks were 65% less likely than nonblacks to be eligible for treatment (28.1% > 17.0%; relative risk, 1.65; 95% confidence interval, 1.46-1.87; P < 0.001). Blacks were more likely to be ineligible due to neutropenia (14% versus 3%, P < 0.001), anemia (7% versus 4%, P = 0.02), elevated glucose (8% versus 3%, P < 0.001), and elevated creatinine (5% versus 1%, P < 0.001).
  
  
  CONCLUSIONS
  Largely due to a higher prevalence of neutropenia and uncontrolled medical conditions, blacks were significantly less likely to be eligible for HCV treatment. Increased access to treatment may be facilitated by less conservative neutrophil requirements and more effective care for chronic diseases, namely, diabetes and renal insufficiency.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. mmelia4@jhmi.edu
authors.forename: Michael T
authors.initials: MT
authors.lastname: Melia
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Muir
authors.forename: Jonathan
authors.initials: J
authors.lastname: McCone
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Shiffman
authors.forename: John W
authors.initials: JW
authors.lastname: King
authors.forename: Steven K
authors.initials: SK
authors.lastname: Herrine
authors.forename: Greg W
authors.initials: GW
authors.lastname: Galler
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Bloomer
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Nunes
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Brown
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Mullen
authors.forename: Natarajan
authors.initials: N
authors.lastname: Ravendhran
authors.forename: Reem H
authors.initials: RH
authors.lastname: Ghalib
authors.forename: Navdeep
authors.initials: N
authors.lastname: Boparai
authors.forename: Ruiyun
authors.initials: R
authors.lastname: Jiang
authors.forename: Stephanie
authors.initials: S
authors.lastname: Noviello
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Brass
authors.forename: Janice K
authors.initials: JK
authors.lastname: Albrecht
authors.forename: John G
authors.initials: JG
authors.lastname: McHutchison
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sulkowski
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications; D000998:Antiviral Agents / Q000627:therapeutic use*; D044383:Black People; D048909:Diabetes Complications; D004608:Eligibility Determination / Q000639:trends*; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006526:Hepatitis C / Q000188:drug therapy* / Q000208:ethnology*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000150:complications; D016896:Treatment Outcome; D014481:United States; D044465:White People; D001741:Black or African American
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a