title: African americans are less likely to have clearance of hepatitis C virus infection: the findings from recent U.S. population data.
abstract: BACKGROUND
  Hepatitis C virus (HCV) is the most common cause of chronic liver disease in the United States. African Americans are known to have a higher prevalence of HCV and lower response to anti-HCV therapy.
  
  
  OBJECTIVE
  The aim of this study is to assess the differences in the prevalence of chronic HCV infection in according to patients' ethnic background.
  
  
  METHODS
  We used the recent National Health and Nutrition Examination Survey with extensive clinical and laboratory data. Active HCV infection was defined as having HCV-positive antibody with detectable HCV RNA by polymerase chain reaction. HCV clearance was defined as HCV-positive antibody with negative HCV RNA. Clinico-demographic data were compared between anti-HCV positive individuals with or without HCV clearance. The stratum-specific χ test for independence was used. Logistic regression was used to identify independent predictors of HCV clearance. P-values ≤0.05 were considered statistically significant. All analyses were run using SAS 9.1 and SUDAAN 10.0.
  
  
  RESULTS
  The cohort included 14,750 adults (age 47.6 ± 0.75 y, 64% white, 21% African American, 10% Hispanics, and 63% male). Of these, 1.32 ± 0.11% were anti-HCV positive with 75.94 ± 4.72% having active HCV viremia. The only parameter significantly different between those who did or did not clear HCV was the proportion of African Americans: 8.0 ± 3.7% versus 24.9 ± 5.0%, P=0.0163. Indeed, the rate of HCV clearance was lowest among African Americans (9.3 ± 3.5%) as compared with both whites (27.2 ± 6.5%) and Hispanics 31.2 ± 9.1% (P<0.05). In multivariate analysis, the only independent predictor of active HCV infection was African American race: odds ratio (95% confidence interval)=3.80 (1.31-11.06), P=0.0151.
  
  
  CONCLUSIONS
  African Americans not only have lower response to anti-HCV therapy but also are less likely to naturally clear HCV, potentially contributing to higher prevalence of HCV.
authors.affiliation: Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA 22042, USA.
authors.forename: Heshaam M
authors.initials: HM
authors.lastname: Mir
authors.forename: Maria
authors.initials: M
authors.lastname: Stepanova
authors.forename: Mariam
authors.initials: M
authors.lastname: Afendy
authors.forename: Marcelo
authors.initials: M
authors.lastname: Kugelmas
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood*; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D014766:Viremia / Q000453:epidemiology* / Q000208:ethnology / Q000821:virology
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral