Hepatitis B and elders: An underestimated issue

Abstract

As the world's population becomes older, the burden of hepatitis B virus in elderly has to be considered. The liver changes with aging and its function is eventually altered. The prevalence of hepatitis B virus is paradoxically more important in elderly in areas having vaccination programs, because of a loosening of the prevention in older patients. Some differences in hepatitis B presentation must be enhanced in elderly: lower spontaneous hepatitis B surface antigen clearance after a recent contamination, major risk of cirrhosis and hepatocarcinoma. Acute hepatitis B seems to be more often symptomatic, with a great risk of chronicity. Hepatocarcinoma linked to hepatitis B virus has a higher prevalence and a different presentation in elderly. Its treatment is the same as in younger people but is less often possible. Liver transplantation is contraindicated after 70 years old. Hepatitis B treatment panel is the same as in younger people (pegylated interferon, nucleoside or nucleotide agents). It gives identical results with no particular adverse events if the precautions for use are followed. Vaccination is less efficient, as in immunocompromised patients, and needs specific protocols.

Diagnostic thresholds and performance of noninvasive fibrosis scores are limited by age in patients with chronic hepatitis B

“…Immune responses that may mediate the manifestation of those liver disorders including CHB and liver fibrosis are also influenced by age . Otherwise, the aging liver often shows several anatomical and physiological changes, such as the reduction in liver volume and blood flow, thereby rendering them more vulnerable to liver injury and susceptible to liver fibrosis …”

Current treatment of hepatitis B virus infections

“…Genotype C is associated with a higher risk of HCC than genotypes A, B, or D, but genotype A2 is associated with HCC in older persons . Especially, the elders require due attention as vaccination is less efficient in the elderly, and liver transplantation is contraindicated at the age over 70 years .…”

Epidemiology of Gastrointestinal Diseases

“…Older adults with HAV have been shown to be more susceptible to develop acute liver failure and have higher mortality (Brown and Persley 2002). Outbreaks of HBV infection have been reported in long-term care facilities, especially in immunosuppressed individuals that undergo assisted blood glucose monitoring (Lanini et al 2009;Loustaud-Ratti et al 2016). The incidence of drug-induced liver injury is higher in the old and tends to be more severe than in younger individuals (Brown and Persley 2002).…”