i read in this book, calledUnderstanding Hepatitis by James L Achord MD that african americans for some reason ,poorly does not respond to treatment. that cant be true. please comment? he saids interferon/riba does not work.
Unfortunately, race, age and gender are all factors in determining response to current HCV therapy. Other factors to consider are body mass index, insulin resistance/diabetes, cholesterol levels; the list is endless. The primary consideration is genotype; but other factors also play a role.
Figure one has a graphic that demonstrates the difference. Unfortunately, although the mechanism is poorly understood, this discrepancy is widely accepted.
Genetics plays a huge role in who responds to interferon, and race is inextricably tied to genetics. I seem to recall Asians (especially Japanese) respond best, then N. Euros, and African-American. I'm sure as more people receive tx in different countries there will be a whole scale of degree of response and we may finally figure out what genes are involved, Or my other idea is to produce 'Consensus-type' IFNs using gene sequences from a wider group of subjects than is curently being tapped.
On the other hand, maybe we could develop HCV resistant people; didn’t I read somewhere recently about a breast cancer resistant fetus? Maybe I’m way off base, but I seem to recall a fuss about that recently.
"...we could develop HCV resistant people..." You may have to rephrase that one to get any kind of funding LOL.
Seriously, a lot of my griping about HCV patent rights and all the $ spent on PIs and 'cocktails' goes back to my gut feeling that any funding pulled away from understanding and deveoping IFN is a distraction.
Yes that's the word in the medical field and I guess quite a few ppl have heard all about this, I think it's the case with quite a few viruses. It seems a little odd but I'm sure there's some kind of logical reasoning behind it all. God Bless
Racial disparity in liver disease: Biological, cultural, or socioeconomic factors.
Nguyen GC, Thuluvath PJ.
Chronic liver diseases are a major public health issue in the United States, and there are substantial racial disparities in liver cirrhosis-related mortality. Hepatitis C virus (HCV) is the most significant contributing factor in the development of chronic liver disease, complications such as hepatocellular carcinoma, and the need for liver transplantation. In the United States, African Americans have twice the prevalence of HCV seropositivity and develop hepatocellular carcinoma at more than twice the rate as whites. African Americans are, however, less likely to respond to interferon therapy for HCV than are whites and have considerably lower likelihood of receiving liver transplantation, the only definitive therapy for end-stage liver disease. Even among those who undergo transplantation, African Americans have lower 2-year and 5-year graft and patient survival compared to whites. We will review these racial disparities in chronic liver diseases and discuss potential biological, socioeconomic, and cultural contributions. An understanding of their underlying mechanisms is an essential step in implementing measures to mollify racially based inequities in the burden and management of liver disease in an increasingly racially and ethnically diverse population.
Hehehe; yeah, that does reek of poor marketing, I suppose :o).
Interesting; if I read you correctly, you feel that IFN is promising enough alone to continue refinement without necessarily adding additional adjunctive therapy? I treat with a large, reputable HCV research and clinical establishment here in California, and I get a lukewarm response re: PI meds from the docs there. Rather ho-hum attitude compared to the fuss I read in here. There doesn’t seem to be much doubt left to me that these will at least be equally as important as an adjunctive as riba was to the original IFN monotherepy. I’d be interested to hear more on this from you—
I agree that PIs will become an important adjunct to SOC in the future. They'd better, considering the time and money that've been expended developing them.
Meanwhile, it's been six years. Where's our pegylated Infergen? Where is a finalized dosing schedule for Albuferon? Why has no one tried hooking a branched PEG molecule onto IFN alpha 2b? And these are just the observations of a casual observer with a HIgh School diploma. What about the truly innovative developments within our grasp, such as race, gender, or genotype specific tx drugs?
It would seem that the 'cocktail' driven approach, adding a third and possibly fourth med into the mix, will be more profitable for those developing them - in the short term. I think a better understanding of IFN and what it can do may be more profitable for all of us in the long run.
It is NOT true that interferon and ribavirin don't work for African Americans. It is true that African Americans don't respond as well and therefore they are treated more aggressively. It doesn't mean that the drugs won't work.
ITS WORKING FOR ME ...IM GENO 2 ALSO...BUT MOST AFRICAN AMERICANS ARE GENO1 AND THATS DIFFUCULT TO TREAT REGARDLESS OF RACE...I WAS SCARED WHEN I FIRST STARTED RESEARCH I CAN ACROSS THESE ..I THOUGHT I WAS DOOMED I WAS UND AT4 WKS...
I've read a few times that certain genotypes of hep C come from different areas of the world...Geno 1 has been around the longest, originating from nothern Africa/ southern Europe, and has had the longest to mutate so it may survive and not kill it's host rapidly. (thus explaining the resistence to treatment.) Geno 2, quite a bit newer in the genetic field, I think originates in Australia, and is less commonly seen (at least in the US)because it's spread to the outside world has been limited up until the last 100 years...The genotype 3 also is newer genetically, and is originally from eastern Asia.It isn't near as common in the US as it is in Japan...and there is a 4, 5 and 6 as well, but I haven't read their origins...It makes you wonder if thats really the "race link" (more people of one race originating from the same area) ...and the success of treating numbers are lopsided because, globally, more people of African decent HAVE geno 1...Hmmm...Pardon my musings...LOL ~Melinda
Kimmypoo, glad to hear you are doing well with your tx, happy trails towards your SVR.
Medicmommy, you made some good musings, as usual that I could appreciate. The answers to the racial disparity have not yet been answered, so your guess is as good or better than mine. The latest study was done in the US and printed March of 2008, that's the one I posted. The one prior to that, I think it was done in 2006 but I could be wrong about that one, that information is from the article Bill posted. It seems that they are no closer to knowing the reason for the racial disparity biologically speaking than they were in the past. There's nothing wrong with your logic on a global scale, however the study was done in the US where most AA's are not from Africa. Also I don't see why the study researchers even mention the socioeconomic factors as those would be fairly obvious no matter what color a person is. I've also read that Asians do better out of all other races, could it be their diet? And could the disparity between AA's and CA's be diet as well? Maybe we will find out someday, what really matters is that all ppl get tx no matter of their color or socioeconomic status. God Bless
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