title: Effect of Treatment for CHC on Liver Disease Progression and Hepatocellular Carcinoma Development in African Americans.
abstract: OBJECTIVE
  African Americans (AA) historically have a low response rate to hepatitis C therapies, and there is limited information available for this patient population regarding the development and treatment of chronic hepatitis C (CHC). The aim of this study was to evaluate liver disease progression and hepatocellular carcinoma (HCC) development in AA with CHC.
  
  
  METHODS
  Between 1995 and 2008, 246 AA patients with CHC were identified from a database of patients and followed until 2012-2013 (average 8 years) or the development of HCC after 2008.
  
  
  RESULTS
  Viral clearance (intent to treat; sustained virus response (SVR)) was achieved in 15% of patients with interferon based therapies with or without ribavirin. AA patients who achieved an SVR (n=22) did not develop HCC or new onset cirrhosis, whereas the HCC incidence in untreated AA patients was 23% (51/203). Patients who achieved an SVR also had improved fibrosis, as defined by the AST Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) score, relative to nonresponders and untreated patients.
  
  
  CONCLUSIONS
  The severity of liver disease at the first visit (except for cirrhosis) correlated with the development of HCC, but because of the overlap in values between patients, these measurements were not useful for predicting individual risk. Since cirrhosis at the first visit was not a predictive factor, treatment with newer antiviral therapies is the best option for reducing the incidence of advanced liver disease and its harmful outcomes in the AA population.
authors.affiliation: Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA.
authors.forename: Naveen
authors.initials: N
authors.lastname: Reddy
authors.affiliation: Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Naylor
authors.affiliation: Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Hakim
authors.affiliation: Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA.
authors.forename: Redwan
authors.initials: R
authors.lastname: Asbahi
authors.affiliation: Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ravindran
authors.affiliation: Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: May
authors.affiliation: Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA.
authors.forename: Murray
authors.initials: M
authors.lastname: Ehrinpreis
authors.affiliation: Department of Internal Medicine/Division of Gastroenterology, Wayne State University School of Medicine, Harper University Hospital, Detroit, MI, USA.
authors.forename: Milton
authors.initials: M
authors.lastname: Mutchnick
keywords: APRI; Cirrhosis; Fib-4; Hepatitis C; Hepatocellular carcinoma