HCV Triple Therapy, The Non-study Experience: A Single Center Analysis Comparing African American to White Americans

Abstract

Purpose: To evaluate qualitative and quantitative differences between African Americans and White Americans in the treatment of HCV in a non-study based setting; the real world experience. Methods: A retrospective case study analysis at a single center that evaluated the efficacy of triple HCV therapy in non study setting. Clinical response and quantitative laboratory values were compared between African-American and non African-American patients throughout the duration of treatment. Patients were included if they started triple therapy treatment after July 2011 and are not a part of any other clinical/pharmaceutical trials. Results: African-Americans were found to have significantly higher BMI and HCV RNA quantitative viral loads at initiation of treatment with triple therapy (either boceprevir or telaprevir; Table 1). Throughout the course of treatment, African Americans had a greater percentage decrease in their baseline hemoglobin and platelet count, and a corresponding reduction in their baseline ribavirin dose. However, treatment outcomes (defined as virus negative at the conclusion of treatment) were not found to be statistically significant between African American and White Americans. A subset analysis (Table 2) revealed that patients who were virus negative at the end of treatment (either telaprevir or boceprevir) were less likely to have received blood transfusions throughout the duration of treatment.Table: Table. HCV triple therapy—African vs white AmericansTable: Table. Treatment outcomesConclusion: Treatment dosages of ribavirin are based upon a patients weight, which corresponds with BMI. Higher doses of ribavirin are more likely to cause cytopenia compared to smaller doses of ribavirin. As a result, patients with higher BMI are more likely to have decreased hemoglobin and platelet counts. In the event a patient develops severe cytopenia, blood transfusion may be necessary. As evidenced in this study, blood transfusion was statistically significant in treatment outcomes - if a patient requires blood transfusions, they are less likely to complete treatment and achieve virus negativity. Larger studies, with greater power, are needed in order to explore other prognostic indicators in the treatment of chronic HCV.