Hepatitis C Virus Infection in the Older Patient

Reid, Michael; Price, Jennifer; Tien, Phyllis C.

doi:10.1016/j.idc.2017.07.014

Cited by 55 publications

(61 citation statements)

References 62 publications

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“…The best therapeutic results for genotype 1a and 1b, utilizing these regimens, ranged from 96.3 to 96.7%, respectively. Patients with genotypes 2 and 3 obtained the lowest SVR rates (92.2% and 90.6%, respectively) and were 1.5 and 2.8 more likely to not have SVR, respectively, when compared to genotype 1a and 1b, a finding that has been confirmed in other studies [19,20,21,22,23,24,25]. .…”

Section: Resultssupporting

confidence: 75%

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A Real-life Study of the Positive Response to DAA-based Therapies for Hepatitis C in Brazil

Vivaldini

Ribeiro

Júnior

et al. 2020

Preprint

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Treating hepatitis C virus (HCV) infections reduces overall mortality and the risk of multiple extrahepatic complications. Direct-acting antivirals (DAAs) are molecules that target specific non-structural proteins of the virus, resulting in the disruption of viral replication and infection. This report describes the activities undertaken to assess the cure of HCV in patients of different age groups, supported by the Viral Hepatitis National Program of the Unified Health System in Brazil. Around 11,000 patients wereevaluated in an electronic retrospective cohort, which used therapeutic schemes with Sofosbuvir (SOF), Daclatasvir (DCV), Simeprevir (SMV), and an association of Ombitasvir, Veruprevir/Ritonavir and Dasabuvir (3D) with or without Ribavirin (RBV), with sustained virologic response (SVR) or viral cure after a 12-week treatment. We conducted logistic regressions to identify factors independently associated with positive response to DAA-based therapies. Among evaluated patients, 57.1% were male; 48.3% identified as white; 78.3% were over 50 years old; 44.1% were from the Southeast region; 47.7% had genotype 1b; and 84.5% were treated for 12 weeks. The SVR rates with DAAs ranged from 87% to 100%. Genotypes 1 and 4 had a better response (96.3 to 100% of SVR) to therapy with DAAs, and genotypes 2 and 3 had SVR of 90.6% to 92.2%. Different treatment periods showed SVR with an average of 95.0% and 95.9% for 12 and 24 weeks, respectively. In the odds ratio assessment, we verified that females were half as likely (OR 0.5; CI 95% 0.4-0.6) to have a negative response to therapy, when compared to males, and that genotypes 2 and 3 were around twice more likely (OR 1.5-2.2; CI 95% 0.7-2.9; 1.2-3.6 and OR 2.7-2.8; CI 95% 2.0-3.8, respectively) to not have SVR after therapy when compared to genotype 1. Patients aged between 50 and 69 years old were 1.2 times (OR 1,2; CI95% 0,7-1,9) more likely to not have SVR when treated with DAAs, when compared to other age groups. This study is the first of this magnitude to be held in a Latin-American country with high SVR results, supported by a free-of- charge universal and public health system. We confirm the high performance of DAA-based therapies which support the Brazilian public health policy decision of adopting them as an important part of the countrys strategy to eliminate HCV by 2030.

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Section: Resultssupporting

confidence: 75%

“…However, when the factor age was analyzed independently, it was not a predictor of a lower SVR in relation to other age groups, according to other published studies [23][24][25] . .…”

Section: Resultsmentioning

confidence: 83%

A Real-life Study of the Positive Response to DAA-based Therapies for Hepatitis C in Brazil

Vivaldini

Ribeiro

Júnior

et al. 2020

Preprint

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“…However, little differences in SVR rates were observed between elderly patients and younger ones. 25 , 26 …”

Section: Discussionmentioning

confidence: 99%

Outcomes and predictors of treatment response with sofosbuvir plus daclatasvir with or without ribavirin in Egyptian patients with genotype 4 hepatitis C virus infection

Ahmed¹,

Elsebaey²,

Fouad³

et al. 2018

IDR

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Background and aimsTreatment of hepatitis C virus (HCV) changed dramatically with the introduction of oral direct-acting antiviral drugs due to their high antiviral potency and safety profile. Sofosbuvir plus daclatasvir combination therapy was extensively investigated in HCV genotypes 1, 2, and 3, while published data regarding its real-life application in the treatment of genotype 4 is lacking. Therefore, we conducted this study to assess the outcomes and predictors of treatment response with sofosbuvir plus daclatasvir with or without ribavirin in Egyptian patients with genotype 4 hepatitis C virus infection.Patients and methodsThis prospective study included 300 Egyptian patients with chronic genotype 4 HCV, treated with sofosbuvir plus daclatasvir with or without ribavirin for 12–24 weeks. Primary outcome was the number of patients who achieved sustained virologic response (SVR12), and secondary outcome was the occurrence of adverse events.ResultsA total of 92.67% of all patients achieved SVR12. SVR12 rates of 96.55% and 84.54% were reported in non-cirrhotic and cirrhotic patients, respectively. SVR12 in treatment-naïve and treatment-experienced patients were 94.12% and 87.01%, respectively. A total of 19.7% of patients experienced mild adverse events. Older age, cirrhosis, and low platelet count were the predictors of treatment non-response.ConclusionBased on this multi-center prospective study, sofosbuvir plus daclatasvir with or without ribavirin for 12–24 weeks appears to have favorable outcomes in the treatment of genotype 4 HCV-infected Egyptian patients. Older age, cirrhosis, especially Child–Pugh class B, and low platelet count are independent risk factors of treatment non-response.

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“…Due to progressive aging of the infected population, management of the elderly HCV‐infected patients significantly emerged in the era of new therapies . Elderly patients are more likely than younger patients to have an increased duration of infection, increased rate of disease progression, and subsequently increased incidence of advanced liver disease . Natural history models predicted that the prevalence of HCV infection and its chronic sequelae will eventually increase through the next decade and will mostly affect those who are greater than 60 years of age.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of sofosbuvir and daclatasvir with or without ribavirin in elderly patients with chronic hepatitis C virus infection

Elbaz

Abdo

Omar

et al. 2018

Journal of Medical Virology

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Hepatitis C virus (HCV) infection is considered as a major public health problem that, worldwide, chronically affects 170 million people. Elderly patients are more likely than younger patients to have increased duration of infection, increased rate of disease progression, and subsequently increased incidence of advanced liver disease. Natural history models predicted that the prevalence of HCV infection and its chronic sequelae as well as extrahepatic manifestations will eventually increase through the next decade and will mostly affect those who are greater than 60 years of age. Moreover, polytherapy and polypharmacy are frequent in elderly patients due to associated comorbidities. As advanced age is associated with increasing risk of development of cirrhosis and hepatocellular carcinoma, elderly patients are in special need of safe and effective antiviral therapies. Achievement of sustained viral responses (SVR) is associated with reduced liver-related complications and overall mortality in such patients with the advanced liver disease. With the recent introduction of interferon-free direct-acting antivirals, successful treatment for chronic HCV infection had dramatically improved, with overall cure rates that exceed 90% SVR. In our study, we aimed to study the efficacy and safety of combined sofosbuvir and daclatasvir, with or without ribavirin, in management of chronically infected HCV elderly patients who are more than 60 years old.

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Hepatitis C Virus Infection in the Older Patient

Cited by 55 publications

References 62 publications

A Real-life Study of the Positive Response to DAA-based Therapies for Hepatitis C in Brazil

A Real-life Study of the Positive Response to DAA-based Therapies for Hepatitis C in Brazil

Outcomes and predictors of treatment response with sofosbuvir plus daclatasvir with or without ribavirin in Egyptian patients with genotype 4 hepatitis C virus infection

Efficacy and safety of sofosbuvir and daclatasvir with or without ribavirin in elderly patients with chronic hepatitis C virus infection

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