Race and Gender Issues: Conference on Viral Hepatitis, Maui, Dec 1999
The response to INF treatment for chronic HCV infection is reportedly greater in Caucasians (Ca) than in African-Americans (AA) and in women than in men. Two posters presented at this conference shed new light on the influences of race and gender on the responses to treatment in patients with chronic HCV infection.
In a study by A. Colantoni and colleagues, Loyola University, Chicago, Illinois, 20 AA and 20 Ca with chronic HCV infection who did not respond to prior treatment with INF received the combination of INF (5 mU/day) plus ribavirin (1000-1200 mg/day) for 6 months. Individuals with three consecutive monthly non-detectable HCV RNA levels and normal ALT levels after 6 months were considered end-of-treatment responders.
It was reported by McCutchison after the Dallas AASLD meeting in Niv '99 that in his large IFN+RBV study African Americans with genotype 1 responded almost comparably (22% vs 28%) as caucasions. A separate study at Dallas reported 96% of African Americans in that study have genotype 1. Individuals with genotype 2 have better response rates to IFN+RBV than individuals with genotype 1.
The response rates were similar in the AA and Ca groups (35% and 40%, respectively). AA patients developed more frequent and severe side effects during combination treatment, particularly hemolytic anemia. The authors concluded that INF plus ribavirin may be a more appropriate therapy for naive AA with chronic HCV infection, and that close monitoring of AA during such treatment is indicated.
The effects of gender and sex hormone status on the response to INF therapy inpatients with chronic HCV infection were examined in a retrospective study by the same researchers. In this study, 65 premenopausal and postmenopausal women and 86 age-matched men with chronic HCV infection were treated with INF (5 mU/day) for six months. Patients with undetectable HCV RNA and normal ALT levels after six months were considered responders.
Overall, the response rate was similar in men (57%) and in women (69%). The response rate was significantly greater in premenopausal women than in age-matched men (74% vs. 56%, p < 0.04) and postmenopausal women (47%, p = 0.04). The researchers proposed that elevated estrogen levels may be associated with greater responsiveness to INF in women with chronic HCV infection.