Prospective Anti-Hepatitis C Virus (Anti-HCV) Trial of Peg-Interferon and Ribavirin in Subjects of First Nations, Metis and Caucasian Ethnicity
Prospective Anti-Hepatitis C Virus (Anti-HCV) Trial of Peg-Interferon and Ribavirin in Subjects of First Nations, Metis and Caucasian Ethnicity
Background:

 According to recent estimates, the prevalence of Chronic Hepatitis C (CHC) in Canada is three
 times more common in First Nations (FN)and Metis compared to non-FN populations. Moreover,
 once infected, the progression of CHC to cirrhosis and/or hepatocellular carcinoma is greater
 in FN patients due to the increased prevalence of alcohol abuse, obesity and diabetes in this
 segment of the population.

 Research Plan:

 This research proposal consists of three parts. The objective of Part I is to document the
 response to anti-viral treatment for CHC among treatment-naïve FN and Metis and Caucasian
 (hereafter referred to as non-FN) patients residing in three urban Western Canadian centres
 (Winnipeg, Saskatoon and Regina). Demographic, clinical and response to treatment data in a
 total of 160 patients (80/group) will be collected at the above centres and transferred to
 the Section of Hepatology at the University of Manitoba for statistical analyses. In Part II,
 the applicants will document and compare the immune responses to HCV proteins throughout the
 course of therapy in FN, Metis and non-FN patients. In the final part, direct economic costs
 of CHC care in FN, Metis and non-FN patients will be ascertained and future costs predicted.

 Hypotheses:

 Part I - The rate of sustained virologic response (SVR) to treatment for CHC is higher in FN
 and Metis compared to non-FN and no Metis patients.

 Part II - The immune response to HCV proteins during anti-viral therapy for CHC is enhanced
 in FN and Metis compared to non-FN and non-Metis patients.

 Part III - The direct costs of health care utilization and delivery for CHC are similar among
 FN and Metis and non-FN and non- Metis patients.
Specific Objectives:

 1. To provide detailed information on the demographics and clinical characteristics of
 treatment-naïve FN and Metis versus non-FN and Non-Metis patients proceeding to
 treatment for CHC.

 2. To document and compare SVR and sustained biochemical response (SBR) rates, adherence to
 therapy, side effects, dose adjustments and discontinuation of treatment between FN and
 Metis and non-FN and Non-Metis patients.

 3. To determine whether the immunologic features associated with SVR (increased NK cell
 activity and enhanced interferon gamma production by CD4 cells in response to viral
 antigens) differ in FN and Metis and non-FN and non-Metis patients.

 4. To document and compare the direct costs of health care utilization and delivery for CHC
 between FN and Metis and non-FN and Non-Metis patients.

 5. Develop a model predicting outcome of therapy, using demographic, clinical and viral
 characteristics, and test the model with race as one of the explanatory variables.

 6. To forecast future prevalence, mortality and medical costs of CHC care in Canada.
Inclusion Criteria:

 -  Adult patients of FN and metis and non-FN descent referred for treatment at the three
 centres will be candidates for this study.