In Chronic HCV, African Americans Have Leaner Livers

ANN ARBOR, Mich., Jan. 3 -- African Americans with chronic hepatitis C (HCV) are significantly less likely than Caucasians to have a fatty liver, according to researchers here.

After controlling for risk factors such as obesity and insulin resistance, African Americans with chronic HCV had a 46% lower occurrence of hepatic steatosis than Caucasians, said Hari Conjeevaram, M.D., of the University of Michigan.

The finding comes from an analysis of volunteers in the Virahep-C trial, a multicenter study of combination peginterferon and ribavirin in the treatment of genotype 1 of chronic HCV, Dr. Conjeevaram and colleagues reported in the January issue of Hepatology.

Steatosis, which has been thought to be associated with a poor response to therapy, is common in chronic HCV and in this study liver biopsy revealed the condition in 63% of patients.

The researchers were able to analyze biopsies from 399 of the 401 patients in the study and found that overall prevalence was similar among 194 African Americans and 205 Caucasians, at 61% and 65% respectively.

Severity was generally mild, with only 6.5% of the patients having moderate to severe fat, the researcher found.

The researchers compared the groups on anthropometric, clinical, and biochemical factors, as well as insulin resistance estimated by the homeostasis model assessment index, or HOMA-IR.

In a univariate analysis, Dr. Conjeevaram and colleagues reported, steatosis was associated with insulin resistance, body mass index, waist circumference, serum triglycerides, aminotransferase level, and histological scores for inflammation and fibrosis.

But after adjusting for those factors -- which tended to be higher in African Americans -- an analysis showed a lower risk of steatosis for African-Americans, compared to Caucasians. The odds ratio was 0.54, with a 95% confidence interval from 0.32 to 0.91, which was significant at P=0.02.

"For a given degree of overweight and obesity or insulin resistance," the researchers said, "African-Americans were approximately half as likely to have hepatic steatosis as Caucasian-Americans."

Even mild steatosis was correlated with increased disease severity, as measured by aminotransferase levels and histological scores for inflammation and fibrosis, the researchers said.

For instance, the researchers said, bridging fibrosis or cirrhosis was twice as prevalent in patients with steatosis as in those without - 45% versus 23%, which was statistically significant at P