Journal of Immigrant and Minority Health

, Volume 21, Issue 3, pp 549–554 | Cite as

Direct-Acting Antiviral Therapy for Hepatitis C Infection in a Large Immigrant Community

  • Amber R. TierneyEmail author
  • William Huepfel
  • Aasma P. Shaukat
  • John R. Lake
  • Mark Boldt
  • Qi Wang
  • Mohamed A. Hassan
Original Paper


Hepatitis C treatment has rapidly evolved with the arrival of direct-acting antiviral therapy. Sustained virologic response (SVR) rates in clinical trials are high but it is unknown how this translates to the immigrant community. Data from December 2013 to September 2015 was collected from a Midwest academic and community practice with a large immigrant population. There were 802 patients with an overall SVR rate of 88%. Ledipasvir/sofosbuvir was associated with favorable response among genotype 1 and 4 patients compared to other regimens (p < 0.001 and p = 0.05). Factors associated with treatment failure included advanced liver disease, male gender, East African/Middle Eastern ethnicity, and non-compliance. Patients with genotype 4 had lower SVR rates than other genotypes (58% vs. 89%, p < 0.001), particularly among East Africans (40% vs. 82% for other ethnicities). Our SVR rate for genotype 4 infection is lower than clinical trials and may be related to cultural, biologic and socioeconomic factors.


Hepatitis C Antiviral Cirrhosis Ethnicity 



No funding was needed to complete this study.

Compliance with Ethical Standards

Conflict of interest

John Lake has received research grants from AbbVie and Mark Boldt has an advisory arrangement for Gilead and AbbVie and is a consultant with AbbVie. All remaining authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was waived from individual participants based on exempt status as a retrospective chart review. This study was reviewed and approved by the Institutional Review Board at the University of Minnesota.

Research Involving Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.


  1. 1.
    Muir AJ. The rapid evolution of treatment strategies for hepatitis C. Am J Gastroenterol. 2014;109(5):628–35.CrossRefGoogle Scholar
  2. 2.
    Kowdley KV, Gordon SC, Reddy KR, et al. Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. N Engl J Med. 2014;370(20):1879–88.CrossRefGoogle Scholar
  3. 3.
    Feld JJ, Kowdley KV, Coakley E, et al. Treatment of HCV with ABT-450/r-ombitasvir and dasabuvir with ribavirin. N Engl J Med. 2014;370(17):1594–603.CrossRefGoogle Scholar
  4. 4.
    Ferenci P, Bernstein D, Lalezari J, et al. ABT-450/r-ombitasvir and dasabuvir with or without ribavirin for HCV. N Engl J Med. 2014;370(21):1983–92.CrossRefGoogle Scholar
  5. 5.
    Lawitz E, Sulkowski MS, Ghalib R, et al. Simeprevir plus sofosbuvir, with or without ribavirin, to treat chronic infection with hepatitis C virus genotype 1 in non-responders to pegylated interferon and ribavirin and treatment-naive patients: the COSMOS randomised study. Lancet. 2014;384(9956):1756–65.CrossRefGoogle Scholar
  6. 6.
    Zeuzem S, Dusheiko DM, Salupere R, et al. Sofosbuvir and ribavirin in HCV genotypes 2 and 3. N Engl J Med. 2014;370(21):1993–2001.CrossRefGoogle Scholar
  7. 7.
    Afdhal N, Zeuzem S, Kwo P, et al. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med. 2014;370(20):1889–98.CrossRefGoogle Scholar
  8. 8.
    Jacobson IM, Gordon SC, Kowdley KW, et al. Sofosbuvir for hepatitis C genotype 2 or 3 in patients without treatment options. N Engl J Med. 2013;368(20):1867–77.CrossRefGoogle Scholar
  9. 9.
    Lawitz E, Mangia A, Wyles D, et al. Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med. 2013;368(20):1878–87.CrossRefGoogle Scholar
  10. 10.
    Molina JM, Orkin C, Iser DM, et al. Sofosbuvir plus ribavirin for treatment of hepatitis C virus in patients co-infected with HIV (PHOTON-2): a multicentre, open-label, non-randomised, phase 3 study. Lancet. 2015;385(9973):1098–106.CrossRefGoogle Scholar
  11. 11.
    U.S. Census Bureau (2010). The foreign-born population from Africa: 2008–2012. 2014/acs/acsbr12-16.pdf. Accessed 11 Dec 2015
  12. 12.
    Lopez-Velez R, Turrientes C, Guiterriez C, Mateos M. Prevalence of hepatitis B, C, and D markers in Sub-Saharan African immigrants. J Clin Gastroenterol. 1997;25(4):650–2.CrossRefGoogle Scholar
  13. 13.
    Shire AM, Sandhu DS, Kaiya JK, et al. Viral hepatitis among somali immigrants in Minnesota: association of hepatitis C with hepatocellular carcinoma. Mayo Clin Proceed. 2012;87(1):17–24.CrossRefGoogle Scholar
  14. 14.
    U.S Census Bureau (2010). The Asian population: 2010. Accessed 11 Dec 2015
  15. 15.
    Kamal SA, Nasser IA. Hepatitis C genotype 4: what we know and what we don’t yet know. Hepatology. 2008;47(4):1371–83.CrossRefGoogle Scholar
  16. 16.
    Wantuck JM, Ahmed A, Nguyen MH. Review article: the epidemiology and therapy of chronic hepatitis C genotypes 4, 5, and 6. Aliment Pharmacol Ther. 2014;39:137–47.CrossRefGoogle Scholar
  17. 17.
    Ruane PJ, Ain D, Stryker R, et al. Sofosbuvir plus ribavirin for the treatment of chronic genotype 4 hepatitis C virus infection in patients of Egyptian ancestry. J Hepatol. 2015;62(5):1040–6.CrossRefGoogle Scholar
  18. 18.
    Doss W, Shiha G, Hassany M, et al. Sofosbuvir plus ribavirin for treating Egyptian patients with hepatitis C genotype 4. J Hepatol. 2015;63(3):581–5.CrossRefGoogle Scholar
  19. 19.
    Kohli A, Kapoor R, Sims Z, et al. Ledipasvir and sofosbuvir for hepatitis C genotype 4: a proof-of-concept, single-centre, open-label phase 2a cohort study. Lancet Infect Dis. 2015;15(9):1049–54.CrossRefGoogle Scholar
  20. 20.
    Hezode C, Asselah T, Reddy KR, et al. Ombitasvir plus paritaprevir plus ritonavir with or without ribavirin in treatment-naive and treatment-experienced patients with genotype 4 chronic hepatitis C virus infection (PEARL-I): a randomised, open-label trial. Lancet 2015;385(9986):2502–9.CrossRefGoogle Scholar
  21. 21.
    Reddy KR, Bourliere M, Sulkowski M, et al. Ledipasvir and sofosbuvir in patients with genotype 1 hepatitis C virus infection and compensated cirrhosis: an integrated safety and efficacy analysis. Hepatol. 2015;62(1):79–86.CrossRefGoogle Scholar
  22. 22.
    Wilson EM, Kattakuzhy S, Sidharthan S, et al. Successful retreatment of chronic HCV genotype-1 infection with ledipasvir and sofosbuvir after initial short course therapy with direct-acting antiviral regimens. Clin Infect Dis. 2016;62(3):280–8.CrossRefGoogle Scholar
  23. 23.
    Wyles D, Pockros P, Morelli G, et al. Ledipasvir-sofosbuvir plus ribavirin for patients with genotype 1 hepatitis C virus previously treated in clinical trials of sofosbuvir regimens. Hepatol. 2015;61(6):1793–7.CrossRefGoogle Scholar
  24. 24.
    Lawitz E, Flamm S, Yang JC, et al. Retreatment of patients who failed 8 or 12 weeks of ledipasvir/sofosbuvir-based regimens with ledipasvir/sofosbuvir for 24 weeks. J Hepatol. 2015;62(S2):S192.CrossRefGoogle Scholar
  25. 25.
    Osinusi A, Marti M, Kohli A, et al. Sofosbuvir/ledipasvir in retreatment of HCV genotype-1 patients who previously failed sofosbuvir/ribavirin therapy. [Abstract 011.] 49th Annual Meeting of the European Association for the Study of the Liver (EASL). April 9–13, 2014a; London, United Kingdom.Google Scholar
  26. 26.
    Lawitz E, Poordad FF, Pang PS, et al. Sofosbuvir and ledipasvir fixed-dose combination with and without ribavirin in treatment-naive and previously treated patients with genotype 1 hepatitis C virus infection (LONESTAR): an open-label, randomised, phase 2 trial. Lancet. 2014;383(9916):515–23.CrossRefGoogle Scholar
  27. 27.
    Poordad F, Hezode C, Trinh R, et al. ABT-450/r-ombitasvir and dasabuvir with Ribavirin for hepatitis C with cirrhosis. N Engl J Med. 2014;370(21):1973–82.CrossRefGoogle Scholar
  28. 28.
    Foster GR, Pianko S, Cooper C, et al. Sofosbuvir + peginterferon/ribavirin for 12 weeks vs sofosbuvir + ribavirin for 16 or 24 weeks in genotype 3 HCV infected patients and treatment-experienced cirrhotic patients with genotype 2 HCV: the BOSON study. [Abstract L05.] 50th Annual Meeting of the European Association for the Study of the Liver (EASL). April 22–26, 2015; Vienna, Austria.Google Scholar
  29. 29.
    Kau A, Vermehren J, Sarrazin C. Treatment predictors of a sustained virologic response in hepatitis B and C. J Hepatol. 2008;49(4):634 – 51.CrossRefGoogle Scholar
  30. 30.
    Guidance HCV. Recommendations for Testing, Managing, and Treating Hepatitis C. Accessed 5 Jan 2018
  31. 31.
    Morrison TB, Wieland ML, Cha SS, et al. Disparities in preventative health services among Somali immigrants and refugees. J Immigr Minor Health. 2012;14(6):968–74.CrossRefGoogle Scholar
  32. 32.
    Nguyen GC, Thuluvath PJ. Racial disparity of liver disease: biological, cultural, or socioeconomic factors. Hepatol. 2008;47(3):1058–66.CrossRefGoogle Scholar
  33. 33.
    U.S. Census Bureau (2009). American community survey. Accessed 11 Dec 2015
  34. 34.
    Omland LH, Osler M, Jepsen P, et al. Socioeconomic status in HCV infected patients- risk and prognosis. Clin Epidemiol. 2013;5:163–72.CrossRefGoogle Scholar
  35. 35.
    Dalgard O, Jeanssen S, Skaug K, et al. Hepatitis C in the general adult population of Oslo: prevalence and clinical spectrum. Scand J Gastroenterol. 2003;38(8):864–70.CrossRefGoogle Scholar
  36. 36.
    Ge D, Fellay J, Thompson AJ, et al. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature. 2009;461(7262):399–401.CrossRefGoogle Scholar
  37. 37.
    Jin R, Cai L, Tan M, et al. Optimum ribavirin exposure overcomes racial disparity in efficacy of peginterferon and ribavirin treatment for hepatitis C genotype 1. Am J Gastroenterol. 2012;107(11):1675–83.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Amber R. Tierney
    • 1
    Email author
  • William Huepfel
    • 1
  • Aasma P. Shaukat
    • 2
  • John R. Lake
    • 1
  • Mark Boldt
    • 3
  • Qi Wang
    • 1
  • Mohamed A. Hassan
    • 1
  1. 1.Department of Internal Medicine, Division of Gastroenterology, Hepatology and NutritionUniversity of MinnesotaMinneapolisUSA
  2. 2.Division of GastroenterologyMinneapolis Veterans Affairs Health Care SystemMinneapolisUSA
  3. 3.Minnesota Gastroenterology, P.A.St. PaulUSA

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