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Hepatitis C Virus Clearance in Older Adults

Antonio Massimo Ippolito1, Angelo Iacobellis1, Michele Milella2

  • 1Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy.

Journal of the American Geriatrics Society
|November 15, 2017
PubMed

Insights

Older adults (80+) with Hepatitis C Virus (HCV) infection achieved high sustained viral response (SVR) rates using direct-acting antiviral (DAA) therapy. DAAs are safe and effective, with specific patient factors predicting better outcomes.

Area of Science:

  • Hepatology
  • Geriatric Medicine
  • Infectious Diseases

Background:

  • Chronic Hepatitis C Virus (HCV) infection poses significant health risks, particularly in older adult populations.
  • Direct-acting antiviral (DAA) therapies have revolutionized HCV treatment, but data on very elderly individuals are limited.
  • Assessing treatment efficacy and safety in adults aged 80 and above is crucial for optimizing care.

Purpose of the Study:

  • To evaluate the sustained viral response (SVR) rates in individuals aged 80 and older treated with direct-acting antiviral (DAA) therapy for Hepatitis C Virus (HCV).
  • To assess the safety and global clinical effect of various DAA combinations in this elderly cohort.
  • To identify risk factors for adverse events in older adults undergoing DAA treatment for HCV.

Main Methods:

  • A cohort of 253 participants aged 80 and older with chronic HCV infection (213 with cirrhosis, 40 with advanced fibrosis) was studied.
  • Treatment efficacy and safety were investigated using different DAA combinations.
  • Participants were staged using Child-Pugh-Turcotte, MELD, and D'Amico systems; comorbidities and clinical events were meticulously recorded.

Main Results:

  • Ninety-five percent of participants achieved SVR, irrespective of sex, HCV genotype, or treatment schedule.
  • During a mean follow-up of 14 months, 34 events occurred in 27 participants, including hepatocellular carcinoma, hepatic decompensation, nonhepatic events, and deaths.
  • Multivariate analysis identified D'Amico Stages 4-5, low baseline serum albumin (<3.5 mg/dL), and ≥3 comorbidities as risk factors for adverse events.

Conclusions:

  • Direct-acting antiviral (DAA) therapy is safe and effective for older adults (80+) with HCV-related advanced fibrosis or cirrhosis in a real-world setting.
  • Patients with preserved albumin synthesis and fewer than three baseline comorbidities are most likely to benefit from DAA therapy.
  • These findings support the use of DAAs in the elderly population, with careful consideration of individual risk factors.
Abstract

Keywords:
HCVchronic hepatitisdirect-acting antiviralsoctogenarians

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