The Latino community in the US is an ethnically diverse minority group made up of people from Mexico, Puerto Rico, Cuba, and numerous other countries in Central and South America. Latinos make up the largest and most rapidly growing minority group in the US. According to 2012 estimates, there are over 50 million Latinos living in the US. As a group, Latinos make up 16.9% of the US population and by 2050 are projected to make up a quarter of the population.1,2
Prevalence of HCV among Latinos
Hepatitis C virus (HCV) infection appears to affect Latinos more frequently than white non-Latinos in the US population. Estimates from the National Health and Nutrition Examination Survey (NHANES) (1988-1994) put the prevalence of HCV in the Latino population at 2.1%, above prevalence estimates for the white non-Latino population (1.5%). Other more recent estimates based on results from 2007-2010 NHANES and Hispanic Community Health Study/Study of Latinos (HCHS/SOL) found that the frequency of HCV varied greatly among different Latino groups, with the highest prevalence found among Puerto Rican men (11.6%).3,4
How HCV affects Latinos
Results from studies examining how HCV affects Latinos showed that chronic HCV is more aggressive in Latinos than in any other ethnic group. One study conducted in the area of Los Angeles, California, found that HCV-positive Latinos tended to have higher levels of liver enzymes (an indication of decreased liver function). The study also found that progression of fibrosis occurred more quickly in Latinos compared with non-Latinos.5,6 Another study found that Latinos with HCV were more likely to have steatosis (fatty liver disease) than white non-Latinos.7
A number of factors may contribute to greater HCV disease severity and more rapid progression of HCV among Latinos. These include the greater likelihood of certain health disorders, including metabolic syndrome (a condition that increases risk for type 2 diabetes and cardiovascular disease), insulin resistance (a condition associated with being overweight that leads to type 2 diabetes), and fatty liver disease. Metabolic syndrome, which is characterized by abdominal obesity (extra weight concentrated around the hips and waist), high lipid levels, high blood pressure, and insulin resistance, is more common among Latinos than white non-Latinos. Type 2 diabetes is also more common among Latinos. There may also be genetic differences among certain Latino groups that contribute to greater HCV severity and less favorable response to treatment. Genetic factors have been identified that predispose Latinos to both metabolic syndrome and type 2 diabetes. Additionally, more frequent alcohol consumption contributes to HCV disease progression. Heavy alcohol consumption is three times more common among Mexican American and Puerto Rican American men compared with non-Latino men.8
Barriers to HCV care
There continue to be substantial barriers to access for medical care among Latinos in the US and these represent obstacles to HCV diagnosis and treatment. Barriers include language, cultural differences, and socioeconomic factors, including lack of medical insurance.
HCV treatment in Latinos
The more rapid progression of HCV in Latinos may explain why responses to antiviral treatment tend to be lower. One study conducted in US Veterans Administration (VA) medical centers looked at rates of sustained virology responses (SVR) (the key measure of the effectiveness of antiviral HCV treatments) with interferon + ribavirin and found that Latinos tended to have lower rates of SVR than white non-Latinos (14.8% versus 22.5%).7
The LATINO Study evaluated the impact of ethnicity on the efficacy of peginterferon + ribavirin in people with HCV genotype 1 infection who had not received prior treatment. The study included 269 Latinos and 300 non-Latinos who received peginterferon + ribavirin for 48 weeks. Non-Latinos had significantly higher rates of SVR than Latinos (49% vs. 34%).9
The addition of protease inhibitor therapy (telaprevir [Incivek], boceprevir [Victrelis], and simeprevir [Olysio]) or polymerase inhibitor therapy with sofosbuvir (Sovaldi) to peginterferon + ribavirin has greatly improved SVR rates across all patient groups. For instance, the Phase 3 studies (ADVANCE and ILLUMINATE) comparing Incivek + peginterferon + ribavirin to peginterferon + ribavirin in people with HCV genotype 1 who were treatment-naive found that the Incivek combination resulted in substantially higher rates of SVR among Latino participants compared with peginterferon + ribavirin (72% versus 39%). A number of newer antiviral treatment regimens are being studied, including interferon-containing and -free regimens with protease inhibitors and polymerase inhibitors, and may offer improved response rates, with greater likelihood of cure for Latino people with HCV.10