Ethnic Variations in Extrahepatic Manifestations in Chronic HCV Patients in BC

Overview

This population-based study in British Columbia reveals significant ethnic disparities in extrahepatic manifestations (EHMs) among chronic hepatitis C virus (HCV) patients. South and East Asian individuals exhibited higher incidence and risk of chronic kidney disease, end-stage renal disease, type 2 diabetes, stroke, and major adverse cardiac events, particularly when untreated. HCV treatment largely mitigated these disparities except for diabetes.

Background

Chronic hepatitis C virus infection is associated with various extrahepatic manifestations (EHMs) including renal, cardiovascular, metabolic, and neurocognitive disorders. Ethnic minorities, particularly East and South Asians, represent a substantial portion of the HCV-infected population in British Columbia but face delays in diagnosis and treatment. Prior research suggests ethnic disparities in HCV-related morbidity, yet data on EHMs by ethnicity remain limited. Understanding these disparities is critical for targeted screening, treatment prioritization, and reducing health inequities.

Data Highlights

Key Findings

• South and East Asian individuals with chronic HCV have higher incidence rates of CKD, ESRD, T2DM, stroke, and MACE compared to other ethnicities.
• Untreated South Asians showed significantly increased risk of CKD/ESRD (aHR 1.27) and T2DM (aHR 2.12).
• Ethnic disparities in EHMs were most pronounced among untreated individuals.
• Following HCV treatment completion, disparities in EHMs largely diminished except for persistent higher risk of diabetes.
• Spontaneous clearance of HCV was also associated with reduced ethnic disparities in EHMs.
• The study underscores the importance of linkage to HCV treatment to reduce ethnic health disparities.

Clinical Implications

Clinicians should recognize the elevated risk of EHMs, particularly renal and metabolic complications, among South and East Asian patients with chronic HCV, especially if untreated. Prioritizing timely HCV treatment in these populations may substantially reduce the burden of EHMs and associated health disparities. Enhanced screening and monitoring for diabetes and kidney disease are warranted in Asian HCV-infected patients.

Conclusion

This study highlights significant ethnic disparities in extrahepatic manifestations among chronic HCV patients in British Columbia, with South and East Asians disproportionately affected. HCV treatment plays a crucial role in mitigating these disparities, emphasizing the need for targeted public health interventions to improve treatment access.

References

1. BC Hepatitis Testers Cohort Study -- Ethnic Variations in Extrahepatic Manifestations in Chronic HCV Patients