Risk Factors (Rfs), Novel Genotypes, and Treatment Outcomes in Southeast Asians (Seas) with Chronic Hepatitis C

Abstract

Purpose: SEAs have a large liver disease burden with HCV and HBV, both of which can cause hepatocellular carcinoma (HCC). The annual HCC incidence in Vietnamese males is 54.3/100,000, 2× that of Chinese males and 8× that of Caucasian males in California. However, SEAs remain one of the least studied HCV patient groups. Our goal is to study treatment outcomes in SEAs with HCV and identify factors that predict sustained-virological-response (SVR). Methods: A total of 445 consecutive SEA patients evaluated by 5 U.S. community gastroenterologists between 12/00–1/08 were included in the study. Treatment outcomes with end-of-treatment response (ETR) and SVR were analyzed using intention-to-treat analysis for 181 treatment-naive patients treated with pegylated-interferon (PEG-INF) and ribavirin (RBV). Treatment adherence is defined as completion of ≥ 80% PEG-IFN and RBV dose for ≥ 80% intended duration. Results: The majority (64%) of our cohort had no identifiable RFs for HCV (Figure 1). At baseline, 13% had clinical characteristics of cirrhosis and 4% had HCC. A total of 375 patients had genotype testing. Distribution of genotype 1, 2/3, and 6 were 57%, 14%, and 30%. Treatment response in 181 treatment-naïve patients was described in Figure 2. SVR in patients with genotypes 6 treated for 48 weeks was similar to patients with genotypes 2/3 (76% vs. 83%, P= 0.48). However, patients with genotype 6 treated for 24 weeks had similar SVR to genotype 1 (56% vs. 57%, P= 0.95). On multivariate analysis also inclusive of weight and sex, independent predictors for SVR were older age (OR = 0.95, P= 0.007), genotype 6 treated for 48 weeks vs. genotype 1 (3.9, P= 0.019), and treatment adherence (OR = 7.1, P < 0.0001).FigureFigureConclusion: Given the lack of identifiable RFs and high prevalence (7%) of HCV in SEA, all patients from this area should be screened for HCV. HCV genotype 6 is common in patients from SEA (30%). Patients with genotype 6 can expect to have a favorable SVR rate as patients with genotype 2/3 if treated for 48 weeks.