1. Peginterferon Alfa-2a and Ribavirin in Latino and Non-Latino Whites with Hepatitis C January 15, 2009 Maribel Rodriguez-Torres, M.D., Lennox J. Jeffers, M.D., Muhammad Y. Sheikh, M.D., Lorenzo Rossaro, M.D., Victor Ankoma-Sey, M.D., Fayez M. Hamzeh, M.D., Ph.D., Paul Martin, M.D., for the Latino Study Group Dr CENDRELLA HOJEILY PGYIII

3. Sequential steps for managing and treating patients with chronic HCV infection, genotype 1(4,6) Reproduced with permission from:AASLD: the American Association for the Study of Liver Diseases. Hepatology 2004; 39:1147.

4. Sequential steps for managing and treating patients with chronic HCV infection, genotype 2 or 3(5) Reproduced withpermission from:AASLD: the American Association for the Study of Liver Diseases. Hepatology 2004; 39:1147.

5. Background Race has been shown to be a factor in the prevalence and the response to therapy for hepatitis C virus (HCV) infection 2.1% Mexican Americans vs 1.5% non-Hispanic white NEngl J Med1999 Latinos and other ethnic subpopulations have been underrepresented in clinical trials

6. Am J Med. 2004 Differences in treatment outcome for hepatitis C among ethnic groups. A total of 661 patients. Sustained virologic response was highest among Asians (61% [22/36]), followed by whites (39% [193/496]), Hispanics (23% [18/79]), and African Americans (14% • P R Health Sci J. 2004 Response to combination therapy of interferon alfa-2b plus ribavirin in Hispanics with chronic hepatitis C.Hispanic patients had a low response rate to combination therapy

9. Prospective multicentric (52 centers) non randomized • INCLUSION CRITERIA: • Latino: spanish speaking countries I (south and central America, mexico and carabbean) • HCV RNA >10 IU/ml • High LFT • Compensated LD ( CHILD PUGH <6) • CIRRHOSIS 10% IN BOTH GROUP • EXCLUSION CRITERIA: • Hb <12 female < 13 male • WBC <11.5 10 9 plt <100 000 • Drug abuse last 12 months or all other liver diseases hepA,B,HIV • Severe psychiatric D/O • Clinically significant cardiac, renal, seizure and retinopathy

10. I OUTCOME: Sustained virologic response defined as undetectable HCV RNA level (<28IU/ml) 24 weeks after the end of treatment period (week 72) • II OUTCOME: VR during all the treatment period • Rapid virologic responses (undetectable HCV RNA at week 4) • Complete early virologic response(undetectable HCV RNA at week 12) • Virologic response at week 24 • Virologic response at week 48 • Relapse between 48 & 72 weeks

11. Methods

16. Conclusions • Latino with HCV I have lower response to standard therapy with peginterferon and ribavirin vs non latino • Baseline viral load predictive of SVR as previous studies • Low ALT predicted of better response in latino; the opposite for non-latino • BMI not related to SVR

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