Treatment Eligibility and Outcomes in Elderly Patients with Chronic Hepatitis C: Results from the VA HCV-001 Study

Abstract

Among veterans over the age of 60 with chronic hepatitis C who are referred for treatment, relatively few are considered treatment candidates and an even smaller number are ultimately treated. After adjusting for co-morbidities, age remains a strong predictor of not being a treatment candidate. In contrast, older age does not seem to adversely affect treatment outcomes and side effects.

Hepatitis C Infection in the Elderly

“…Because elderly patients were less likely to be treated than younger ones [31], testing may not be performed. One study shows only 25 % of patients over the age of 60 were considered to be treatment candidates by the evaluating clinician, and only 10 % were started on treatment in 2008 [74]. After adjustment for potential confounders, older age remained associated to a lower likelihood of being considered a treatment candidate (adjusted OR 0.43, 95 % CI 0.30-0.61) [74].…”

“…One study shows only 25 % of patients over the age of 60 were considered to be treatment candidates by the evaluating clinician, and only 10 % were started on treatment in 2008 [74]. After adjustment for potential confounders, older age remained associated to a lower likelihood of being considered a treatment candidate (adjusted OR 0.43, 95 % CI 0.30-0.61) [74]. In our review, elderly patients were shown to have higher prevalence and more rapid progression of advanced fibrosis, thus, leading to greater complications of cirrhosis and HCC.…”

Hepatitis C Virus Infection in the Older Patient

“…Prior to the advent of DAA agents, some 58,59 but not all studies 13,60 found that HCV-infected patients that were of older age had worse sustained virologic response (SVR) rates than those that were of younger age. Some attributed the worse response to the more frequent treatment discontinuation and/or dose reductions in the older patient resulting from treatment with an interferon-based regimen plus ribavirin, which are often accompanied by adverse effects including cytopenia, flu-like symptoms, and central nervous system effects.…”

Development of hepatocellular carcinoma in elderly patients with chronic hepatitis C with or without elevated aspartate and alanine aminotransferase levels

“…The sustained virological response to antiviral treatment in aged patients is reported to be either poorer than [30Á32] or comparable with that in younger patients [19,33]. The difference is most likely ascribed to careful selection of the aged patients who would benefit from treatment [13].…”