title: Challenges of hepatitis C treatment in Native Americans in two North Dakota medical facilities.
abstract: BACKGROUND
  The prevalence of chronic liver disease (CLD) in the Aboriginal North American population is disproportionately higher than that of the non-indigenous population. Hepatitis C virus (HCV) is the second leading cause of CLD in American Indians or Alaska Natives (AIANs). This study described the experience of two teaching community medical centers in North Dakota in treating HCV infection among AIANs and compared treatment outcomes to a cohort of Caucasian patients.
  
  
  METHODS
  The retrospective study described the characteristics and proportion of AIAN patients with HCV who received treatment. Documented reasons for not receiving treatment were analyzed. For those AIAN patients treated for HCV infection, responses to treatment, including rapid, early and sustained virological responses (SVRs), were compared with those of Caucasians.
  
  
  RESULTS
  Only 22 (18%) of 124 AIANs with HCV infection received treatment. Common reasons for not receiving treatment include lack of access to specialists, concomitant or decompensated liver disease, alcohol and drug abuse and cost. There were no significant differences in the baseline characteristics and key predictors of SVR in AIANs compared to Caucasian controls.
  
  
  CONCLUSIONS
  Most AIAN patients with HCV infection do not receive treatment despite comparable treatment response rates to Caucasians. Further population-based studies, addressing access to specialized hepatitis C treatment and public health concerns are warranted, as it is crucial to treat chronic HCV infection to decrease the burden of disease in the AIAN community.
authors.affiliation: University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA. Sarah.hossain@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Hossain
authors.affiliation: Sanford Health, Fargo, North Dakota, USA. Sajid.Jalil@Sanfordhealth.org.
authors.forename: S
authors.initials: S
authors.lastname: Jalil
authors.affiliation: Sanford Health, Fargo, North Dakota, USA. dubert_md@yahoo.com.
authors.forename: D M
authors.initials: DM
authors.lastname: Guerrero
authors.affiliation: University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA. Abe.sahmoun@med.und.edu.
authors.forename: A E
authors.initials: AE
authors.lastname: Sahmoun
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D060085:Coinfection; D005260:Female; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009658:North Dakota; D015995:Prevalence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D044465:White People
chemical_list: D000998:Antiviral Agents
keywords: Infectious Disease; Medical; North America; Public Health