The emerging importance of chronic hepatitis C infection in Asian Americans

OBJECTIVES: To study the demographics, epidemiology, and natural history of chronic hepatitis C in Asian Americans. METHODS: This retrospective survey describes 260 Asian Americans with chronic hepatitis C referred to one tertiary center. RESULTS: Ninety-two percent of patients were born in Asia. Fifty-one percent reported a history of unsafe therapeutic injections, which was a risk factor only in those with exposure outside the United States (p < 0.0001). A history of transfusion was reported in 41% of patients and was more frequent in those with exposure within the Unites States (p < 0.0001). Only 3.8% reported a history of intravenous drug abuse, which was more frequent in those with exposure within the United States (p < 0.0001). Hepatitis C genotype 1 was detected in 64.2% of patients, genotype 2 in 18.3%, and genotype 6 in 11.3%. Genotype 1 had a significantly lower sustained virologic response rate (32.8%) to interferon treatment, compared with genotype 2 (77.8%) or 6 (69.2%). During a mean follow-up of 6 yr, 26 patients developed hepatocellular carcinoma (HCC). Logistic regression model revealed fibrosis stage 4 (odds ratio [OR] 8.87, 95% confidence interval [CI] 2.97-26.48, p < 0.0001), age at presentation (55 vs 35 yr - OR 3.45, 95% CI 1.22-9.75, p = 0.0194), and baseline albumin level (3.0 vs 4.0 mg/dL - OR 3.47, 95% CI 1.02-11.76, p = 0.0464) were independent predictive factors for HCC development. CONCLUSIONS: Asian Americans with a history of unsafe therapeutic injections must be screened for chronic hepatitis C. Antiviral treatment should be initiated prior to development of cirrhosis. Surveillance for HCC must be routinely performed in cirrhosis patients.