The prevalence of hepatitis C (HCV) in the Native
American population in the United States is believed to be higher than
in the general population. Unfortunately, there have been very few
research papers on Native Americans and hepatitis C. This article
will discuss three papers that have been published.
The first paper examined the prevalence of
hepatitis C in indigenous peoples of Alaska. This included the Yupik,
Inupiat and Aleut peoples who comprise 14.9% of Alaska’s population.
By comparison, Indigenous
Americans who live within the continental United States comprise
approximately 1.2% of the population. A review by the Indian Health
Services (IHS) clinics in Arizona of 1496 people reported a prevalence
of 16%. In California, the IHS reported a 36.3% prevalence in a study
of 344 persons.4
In another journal article2 the Indian
Health Services (IHS) and the Centers for Disease Control and
Prevention (CDC) conducted a chart review of two IHS clinical
facilities. The review was of American Indians (AIs) and Alaska
Natives (ANs) 18 years old or older seen in primary care clinics
between October 01, 2001 through September 30, 2003.
The mean age of the people
(mostly male) in the study was men~40yo, women~42yo; the population
came from 57 different American Indian tribes.
There were 35,712 AI/AN patients
of whom 251 patients (1%) had at least one HCV code sent in. An HCV
EIA (antibody) test was sent in for 209 (83%) patients, and 203 of
these (99%) were antibody positive. Confirmatory testing was
performed in 144 of the 203 (70%) antibody-positive patients. HCV RNA
or viral load was confirmed in 144 patients (100%).
The self-reported risk-factors
were injection drug use (41%); no risk factor reported (38%); blood or
blood products from before 1992 (9%); sexual contact (3%); other (6%);
household contact (3%).
The key points of the study outcomes included:
Confirmatory HCV testing was not obtained in 30% of patients with a positive EIA (antibody test)
A quantitative HCV test (viral load) was obtained in only 52% of patients
Only 39% had a genotype test
Only 12% of patients had a liver biopsy
Only 30% of the patients received a hepatitis A vaccine and 38% received the hepatitis B vaccine
Treatment was only started in 37 of the 144 (26%) patients who had confirmed HCV infection
The Omaha Clinic3
A study was conducted in Omaha, NE at the Fred LeRoy
Health and Wellness Center. A total of two hundred and forty-three
Native Americans were screened (161 females; 82 males). The mean age
was 41 ± 1 yo. Over 30 tribes from across the United States were seen
at the clinic and represented in the study. The majority of the
participants lived in an urban environment—only seven participants
(2.9%) lived on an Indian reservation. The participants were also
asked to fill out a risk factor assessment.
The study participants were
screened for HCV antibodies and a follow-up HCV RNA (viral load) test
was performed to confirm active HCV infection. If a participant
received an HCV RNA positive result a one-on-one counseling session
with a physician to discuss the possible consequences of HCV was
offered, as well as treatment options and counseling on the importance
of avoiding alcohol. A referral to a hepatologist for further
monitoring and possible treatment was also offered.
overall results showed that there was an HCV antibody positive rate of
11.5% (8.1% females; 18.3% males) and the HCV RNA results were reported
at 8.6% (6.2% females; 13.4% males). All the participants who tested
HCV RNA positive were between the ages of 30 to 59 years old (30-39
(13.3%); 40-49 (12.0%); 50-59 (14.3%).
Injection drug use was the number one risk factor followed by receiving
a tattoo more than 5 years ago, having sex with an HCV positive
person, alcoholism, any transfusion, any tattoo and receiving a blood
transfusion before 1992.
Importantly, participation in a
Sun Dance ritual was not a significant factor. The Sun Dance ritual is
a Sioux ceremony that is practiced by many Great Plains Indians. It
includes “flesh offerings,” where 1 or more incisions are made in the
skin of those participating in the ceremony. In the past, one knife
was used, but now tribal-sponsored ceremonies use only sterile,
The study is ongoing and more
data will be collected. The authors also stated that more studies are
needed in larger Native American populations.
The purpose of these future studies will be to:
Confirm the findings in the present study of the risk of acquiring HCV by receiving a tattoo
Assess the prevalence of HCV in Native Americans living on reservations
Improve the level of HCV education
Collect information on genotype
Understand the response to HCV treatment in Native Americans
A special thank you to Lora L.
Langley, RN, BSN for providing a short overview of the study and
providing participants with a copy of the journal article.
There is clearly a need
for more studies to understand the true prevalence of hepatitis C in
the Indigenous Peoples of America. There has not been a published
study on the new direct acting antiviral therapies to treat Indigenous
Americans. But since the new therapies have similar cure rates across
all races and ethnicities, it is expected that the newer therapies will
be just as effective in Indigenous Americans infected with hepatitis
*A future article will focus on Indigenous Peoples of Canada
- Hepatitis C Virus in American Indian/Alaskan Native and Aboriginal Peoples of North America by J. D. Rempel and J. Uhanova
- Journal of Health Disparities Research and Practice Volume 3, Number 3, Number 2, Fall 2009, pp. 59-66 titled Hepatitis C Diagnoses in an American Indian Primary Care Population
- A.S. Neumeister, et al. Hepatitis-C Prevalence in an Urban Native-American Clinic: A Prospective Screening Study. Journal of the National Medical Association, vol. 99, no.4
- Numbers in red are corrected from original Advocate article.
Labels: Alaska Natives, American Indians, Epidemiology, Indigenous Americans, Native Amercans, Native Peoples, Sun Dance