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High Rate of New Hepatitis B Among African-Americans, Study Finds

Black Americans have a higher incidence of hepatitis B virus (HBV) infection than any other racial/ethnic group, including Asian-Americans, according to a review article in the July 1, 2013, advance edition of Clinical Gastroenterology and Hepatology.

An estimated 1.2 million people in the U.S. have chronic hepatitis B, according to the Centers for Diseases Control and Prevention. Over time this can lead to serious liver disease including hepatocellular carcinoma.

HBV is endemic in much of Asia, and in the U.S. Asian-Americans have the highest prevalence, or total infections, often acquired perinatally. But incidence, or new infections, is a different story.

Kimberly Forde from the University of Pennsylvania and colleagues looked at the epidemiology of hepatitis B among African-Americans compared with other population groups, as well as natural history and treatment outcomes.

Results

• In 2010, African-Americans had the highest rate of acute or recent HBV infection, at 1.7 cases per 100,000 persons -- about 4-fold higher than the rate for whites.
• The African-American rate was about 3-fold higher than that of Asian-Americans, at 0.6 per 100,000 persons.
• Most African-Americans (84%) were infected with HBV genotype A, which is associated with a higher risk of hepatocellular carcinoma than other genotypes; genotypes B and C are most common among Asian-Americans.
• Some evidence suggests African-Americans may be genetically more susceptible to chronic HBV infection, or less likely to spontaneously clear the virus after exposure.
• 1 small study found that African-Americans were more likely to respond to antiviral therapy -- including HBV DNA clearance, hepatitis B "e" antigen (HBeAg) loss, and hepatitis B surface antigen (HBsAg) loss -- than other groups.

The study authors noted that most providers do not routinely screen African-American patients for HBV, most people who are infected do not know it, and few have undergone treatment. Furthermore, few studies have looked specifically at outcomes in this population.

It is well known that people of African descent do not respond as well as whites to interferon-based therapy for chronic hepatitis C. In recent years researchers have discovered that this is largely attributable to a lower likelihood of having a favorable IL28B gene pattern associated with interferon responsiveness. Further research is needed to determine what factors influence variations in spontaneous clearance and treatment response among blacks with hepatitis B.

9/11/13

Reference

KA Forde, O Tanapanpanit, KR Reddy, et al. Hepatitis B and C in African Americans: Current Status and Continued Challenges. Clinical Gastroenterology and Hepatology. July 1, 2013 (Epub ahead of print).

Other Source

CM Kukka. The Other Forgotten Hepatitis B Minority -- African-Americans. HCV Advocate. September 2013.