EXTRA RISK FACTORS PLACE INNER-CITY HEPATITIS C PATIENTS AT RISK FOR CHRONIC DISEASE

ORLANDO--In a study of inner-city patients with chronic hepatitis C (HCV) infections, Emory University researchers have found that certain risk factors not only increase these individuals' chances for the development of acute hepatitis C virus (HCV), but also make them particularly vulnerable to developing the chronic form of the disease.

The research was presented at the annual meeting of the American Gastroenterology Association's Digestive Disease Week in Orlando on May 16. Emory digestive diseases specialist Christine Bruno, M.D., Lafaine Grant, M.D., and Joanne Carey, M.S., conducted a year-long, prospective evaluation of risk factors for chronic HCV among inner-city, lower-income patients in a gastrointestinal diseases clinic at Atlanta's Grady Memorial Hospital.

Of the 103 patients studied, 33 were African-American males, 33 were African-American females, 26 were Caucasian males and 11 were Caucasian females. Mean age of the patients was 45. At least one risk factor for HCV was identified in 96% of patients studied, while the majority of patients had two or more risk factors.

The most common risk factor for both male and female Caucasian and African-American patients was drug use, either through injection or cocaine used intranasally. Eighty-one percent of Caucasian males and 60% of African-American males had used drugs, along with 63% of Caucasian females and 45% of African-American females. In addition, three-fourths of Caucasian males reported a history of drug use in their partners, although few African-American males reported such use.

In males without a history of drug use, a large number of lifetime heterosexual partners (>20), was the greatest risk factor. Eighty percent of Caucasian males and 62% of African-American males had had more than 20 partners. In females with no history of drug use, blood transfusions was the largest single risk factor. Three-fourths of Caucasian females and 39% of African- American females had had a blood transfusion. One of three African-American females with no drug use worked in a health care setting. In 4% of patients, no risk factor could be identified.

In addition to those factors identified as responsible for the initial infection, the researchers also found that between 60% and 80% of the patients were significant abusers of alcohol, placing them at increased risk for eventual progression of a chronic condition to end-stage liver disease.

"In studying the inner-city population with chronic HCV infection, not only do we have to deal with the disease itself and how it was acquired, but also with issues such as quality of life and cofactors such as alcohol abuse," Dr. Bruno points out. "Although we know how to prevent end-stage liver disease, if we do not deal with these additional risk factors, the patients will return to drugs or alcohol, and with no protective antibodies will continue to suffer complications from their disease."

Although new cases of hepatitis C virus are actually decreasing in the general population, and a percentage of those with acute HCV do not progress to chronic disease, inner-city patients with HCV are still at high risk, says Dr. Bruno. Complications from chronic HCV leading to end-stage liver disease are expected to peak in about 2010. "It is very rare not to find additional risk factors for chronic HCV disease in the inner city," Dr. Bruno says. "In addition to addressing the demographics of disease and its spectrum, we need to address treatment in terms of the whole person, not just the disease."