The course of elderly patients with persistent hepatitis C virus infection without hepatocellular carcinoma

Area of Science:

• Hepatology
• Geriatric Medicine
• Viral Hepatitis Research

Background:

• Limited understanding of the long-term prognosis for elderly individuals with chronic hepatitis C virus (HCV) infection.
• HCV infection poses unique challenges in older populations due to potential comorbidities and age-related physiological changes.

Purpose of the Study:

• To investigate the clinical course and mortality patterns in elderly patients with persistent HCV infection.
• To identify factors influencing survival and causes of death in this specific demographic.

Main Methods:

• Retrospective analysis of 453 HCV antibody-positive patients aged 80 years and older with confirmed persistent HCV RNA.
• Inclusion criteria: persistent HCV RNA detection, no prior HCV eradication, no history of hepatocellular carcinoma (HCC) before age 80.
• Analysis of mortality rates and causes of death after age 80, stratified by liver fibrosis stage (FIB-4 index).

Main Results:

• The median survival time (MST) after age 80 was 8.8 years, comparable to the general population.
• Non-liver-related diseases accounted for the majority of deaths (74.2%), followed by HCC (18.1%) and other liver diseases (7.7%).
• Patients with advanced liver fibrosis (FIB-4 > 3.25) exhibited significantly shorter MST (7.1 years) compared to those with mild fibrosis (10.2 years) (p=0.020), primarily due to increased liver-related mortality.

Conclusions:

• The primary cause of mortality in elderly patients with persistent HCV infection is non-liver-related disease.
• Liver fibrosis stage is a critical determinant of survival, with advanced fibrosis leading to poorer outcomes and increased risk of liver-related complications, including HCC.