Original article
Racial differences in liver inflammation and fibrosis related to chronic hepatitis C

https://doi.org/10.1016/S1542-3565(04)00162-4Get rights and content

Abstract

Background & Aims: Hepatitis C virus (HCV) infection is more prevalent in black compared with white Americans. However, the natural course of HCV in black patients has not been defined. Methods: We performed a retrospective comparison of initial liver tests, HCV genotype and viral load, and liver histology findings in 87 black and 136 white American chronic hepatitis C patients who were evaluated at the University of Maryland between 1995 and 1998. The liver biopsy examinations were interpreted by using the Knodell Histologic Activity Index (HAI) criteria. Results: Black HCV patients were older (46.3 vs. 43.3 yr; P = 0.004) and were more likely to be infected with HCV genotype 1 (95% vs. 75%). The modes of HCV transmission, estimated duration of HCV infection, and prevalence of alcohol abuse were similar in the 2 groups. Yet, black patients had lower mean total HAI scores (7.6 vs. 8.7; P = 0.021), periportal hepatocyte necrosis scores (P = 0.021), and liver fibrosis scores (P = 0.049). In keeping with less hepatic necroinflammatory activity, black patients had a lower mean serum alanine transaminase (ALT) level (85.5 vs. 122.7; P = 0.002). Black patients also had lower serum iron levels (P = 0.009). There were no racial differences in the prevalence of increased iron studies and hepatic iron loading. Conclusions: Black chronic HCV patients have milder liver necroinflammation and fibrosis than white patients with similar HCV duration. These differences in liver histology were not explained by a variance in hepatic iron loading.

Section snippets

Study design

This retrospective cohort study was approved by the University of Maryland Institutional Review Board. We reviewed the medical records of all patients who were evaluated for chronic HCV at the University of Maryland Hepatology Ambulatory Clinic between 1995 and 1998 and who had liver biopsy slides available for review. Each patient had serum antibodies to HCV (EIA-2; Ortho Diagnostics, Bridgewater, NJ) and detectable serum HCV-RNA levels. The patient’s race was identified as black or white in

Demographic and viral data

The demographic data are summarized in Table 1. Black HCV patients were significantly older than white HCV patients. However, the ratio of women to men, estimated duration of HCV, and modes of HCV transmission (injection drug use, 35.3.5% vs. 32.4%; blood product transfusions before 1992, 20.6% vs. 20.5%; unknown, 23.0% vs. 22.8%) were similar in black and white patients. The prevalence of alcohol abuse was the same in the 2 races (P = 0.11). Ninety-five percent of black patients and 75% of

Discussion

We found significant differences in the clinical and liver biopsy manifestations of chronic HCV in black and white patients. Despite a similar duration of HCV and rate of alcohol abuse, black HCV patients had a lower mean serum ALT level, lower serum iron level, and less liver necroinflammation and fibrosis. These differences in liver histology were not related to varied durations of HCV infection, alcohol abuse, or hepatic iron loading.

Two previous studies have investigated racial and ethnic

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