1. Hepatitis C in Minority Populations Andrea E. Reid, MD, MPH Veterans Affairs Medical Center Washington, DC

2. Hepatitis C Virus Healthcare Impact in United States Approximately 3.2 M chronically infected with HCV Leading cause of cirrhosis, hepatocellular carcinoma Leading indication for liver transplant May cost $80 billion over next 10 years

4. Higher HCV Prevalence in Minorities Study/ PopulationRace/EthnicityPrevalence HCV Antibody % (95% CI) NHANES III 1988-1994 White1.5 (1.1-2.0) Black3.2 (2.6-4.0) Mexican American 2.1 (1.7-2.6) NHANES 1999-2002 White1.5 (1.1-1.9) Black3.0 (2.4-3.9) Mexican American 1.3 (0.8-2.1) Alter MJ NEJM 1999;341:1556-62; Armstrong GL Ann Intern Med 2006; 144:705-714

5. Blacks Have Poorer Response to PEG- IFN and Ribavirin: VIRAHEP-C Conjeevaram HS et al. Gastroenterology 2006; 131:470-7 Caucasian race: OR 1.96 (1.48-2.6) p <0.001 p < 0.00001 for SVR

6. SPRINT-2 Results Hofman WP, Zeuzem S. Nat Rev Gastroenterol Hepatol. 2011 Apr 5. [Epub ahead of print]; Poordad F et al. NEJM 2011; 364:1195- 206

7. Outstanding issues Response of minorities to new HCV drugs Improve minority recruitment in clinical trials Access of minorities to new HCV drugs Monitoring of patients with advanced HCV –Screening for cancer –Liver transplant