HCV Treatment Response Rates for African-Americans

HCV Treatment Response Rates for African-Americans

from Jules: 2 new HCV protease inhibitors (telaprevir [Vertex], boceprevir [Merck]) will be the first to the market expected by Sept 2011. As we head towards a new era in HCV treatment due to new orally administered HCV drugs, where we could project that everyone in the USA can be cured, IF the rollout of these drugs over the next 5+ years is han dled correctly, will we be successful??? This is THE major question. We know that 90% of these patient populations never get into care or are refused or they decline peg/rbv treatment, and after the 10% start therapy only 5-25% achieve a cure, SVR. What about insulin resistance & diabetes as a negative predictor to response to peg/rbv, we know it is a negative response to peg/rbv and we know it is quite prevalent among African-Americans & Latinos and HIV+, but we do not yet know its affect when an oral HCV protease inhibitor will be added to therapy including peg/rbv but my case is it will continue to be a negative predictor to response but in particular for prior nonresponders & null responders. Are we talking about how to address this, NO. The companies and researchers should build this question into their studies, perhaps pretreatment with a diabetes drug like metformin could improve response. A recent breakthrough in research found a major reason why African- Americans respond so poorly to peg/rbv and it also predicts poor res ponse by whites as well, it is the IL28b genotype, which is a key predictor of response to peg/rbv. Soon this test will be made available by laboratories, in particular LabCorp is expected I think to be the first to announce availability very soon. It is still being discussed in key research discussions how this teat will be used but it is expected to be a part of the decision making process of when to begin therapy. Although I suspect its importance will not be that great because even if a patient has the wrong gene which predicts a lower response rate in general, still a significant proportion, 30%+ due respond, so how do you decide not to treat a patient, I think this issue will become key.

"13.7% to 21% among African-Americans mono & coinfected at major clinic Montefiore in Bronx, NY......Sustained virologic response (SVR) was achieved in 21% of their subjects, 35% of our mono-infected, and 22% of our co-infected patients. In addition to the reported negative predictors of SVR, our co-infected patients had high mean HCV viral load and a 14% prevalence of diabetes. A previous study of co-infection from our institution found a 76% prevalence of HOMA-IR>3 (Homeostatic Model Assessment-Insulin Resistance). 2 Nasta et al. report ed an 8% rapid viral response (RVR) rate in co-infected patients wit h high viral load and HOMA>3.3"

Hepatitis C Treatment in an Urban Population
We read with interest the report by Feuerstadt et al.1 demonstrating limited effectiveness of Hepatitis C virus (HCV) therapy in an urban minority ...
www.natap.org/2010/HCV/052410_01.htm

Currently, only a small proportion of those with CH-C are aware of their infection and, of these, just 10% to 27% are offered treatment.....
(Cirrhosis accounted for just 5% of all cases (diagnosed and undiagnosed) of CH-C in 1989, 10% in 1998, and 20% in 2006, the proportion with cirrhosis is projected to reach 24.8% in 2010, 37.2% in 2020, and 44.9% in 2030)

Aging of Hepatitis C Virus (HCV)-Infected Persons in the United ...
HCC in persons older than th e age of 65 years with HCV infection has doubled during the last several years....(The model suggests that decompensation became ...
www.natap.org/2010/HCV/031110_02.htm