Public Release Type:
Journal
Publication Year: 2013
Authors:
Ghany MG,
Sterling RK,
Fried MW,
Hassan MA,
Kim WR,
Li R,
Smith C,
Wahed AS
Studies:
Hepatitis B Research Network
Background/Aims: The majority of Americans with chronic hepatitis B virus (HBV) infection are foreign born. While the prevalence of HBV infection is higher in Americans of African descent than white Americans, detailed data about these 2 groups are scarce. We compare the demographic, epidemiological and clinical characteristics between US-born (USAA) and foreignborn African Americans (FBAA). Methods: Subjects of African descent enrolled in the NIH-funded Hepatitis B Research Network (HBRN) cohort study were identified by self-reported race. Serum HBV DNA and genotype were determined by central laboratories, supplemented by local data. Demographic and disease characteristics were compared between USAA and FBAA. Results: Of 1586 adult participants with chronic HBV infection, 220 were of African descent, including 56 USAA and 163 FBAA (74%). FBAA included 55 from West Africa, 95 from East Africa and 13 from other parts of the world. USAA were older, more likely to have history of sexually transmitted disease (43% versus 9%) or same-gender sex (9% versus 1%) than FBAA (all p<0.05). USAA were more likely to be HBeAgpositive, have higher HBV DNA levels and be characterized by their physician to have HBeAg-positive chronic hepatitis, whereas FBAA were more likely to be inactive carriers. Although genotype A was most common in both groups (81% versus 50%), a substantial proportion of FBAA had genotype E (30%) or D (12%), neither of which was found in USAA. In the comparison between FBAA from West and East Africa, the former were more likely to have abnormal ALT (82% versus 46%, p<0.01) and higher HBV DNA level (3.4 versus 2.7 log10 IU/mL, p<0.01). The predominant genotype among West African FBAA was E (60%), whereas genotypes A (67%) and D (23%) were common in East African FBAA. Conclusion: Significant clinical and virological differences were found between USAA and FBAA, which may be attributable to differences in HBV epidemiology as well as genotype. USAA and West African FBAA appear to have a profile (high ALT and HBV DNA) associated with more active liver disease at enrollment. Longitudinal follow-up is ongoing to determine long-term outcomes.