Natural History of Chronic Hepatitis C in Patients Age 65 and Older

Because many people contracted hepatitis C virus (HCV) years or even decades ago, they are now reaching the age at which long-term liver damage is becoming apparent.

Thierry Poynard, MD, and his team conducted a study to asses the features and severity of chronic hepatitis C and the efficacy and safety of antiviral therapy in patients age 65 or older. In addition, the researchers looked at the use of panels of biochemical markers (FibroTest, FibroSure, ActiTest) as a noninvasive alternative to liver biopsy for assessing the extent of fibrosis.

The study included two groups of patients:

Group 1: a prospective cohort including all 4182 hepatitis C patients seen at Pitie-Salpetriere Hospital in Paris.
Group 2: all 33,738 consecutive patients who received FibroTest/FibroSure or ActiTest in France between 2002 and 2004.

In the two groups combined, there was a total of 6865 patients aged 65 years or older (881 in Group 1 and 5984 in Group 2).

Results

In Group 1, patients aged 65 or more were older at the time of HCV infection and had a longer duration of infection; they were also more likely to have genotype 1 HCV.

More patients over 65 had a history of blood transfusion (P < 0.001) (HCV was identified in 1989, and blood screening began in the early 1990s.)

Among the 2169 Group 1 patients who underwent liver biopsy, bridging fibrosis (stages F2, F3, or F4) was more common among patients age 65 or older, regardless of duration of infection.

In a multivariate analysis, age at biopsy and age at infection were associated with more severe fibrosis.

Older patients were more likely than their younger counterparts to be diagnosed with hepatitis C after experiencing a complication of infection (P < 0.001).

170 elderly patients received antiviral therapy; among those treated with pegylated interferon plus ribavirin, 45% achieved sustained virological response.

In Group 2, at the time they received the FibroTest/FibroSure/Actitest, cirrhosis was observed in 58% of patients over 80 years of age, 37% of those between 65 and 80, and 14% of those younger than 65 (P < 0.001).

Patients over 80 years old who had cirrhosis were more likely to have normal alanine aminotransferase (ALT) compared with patients younger than 65 (43% vs 31%, respectively; P < 0.001).

Conclusion

The authors concluded that among patients aged 65 years or older, chronic hepatitis C is more severe and presents with lower ALT than it does among younger patients. However, they added that treatment is effective and "[b]iochemical markers seem particularly useful as a noninvasive alternative to liver biopsy in this population."

7/14/06

Reference
D Thabut, S Le Calvez, V Thibault, and others. Hepatitis C in 6,865 patients 65 yr or older: a severe and neglected curable disease? American Journal of Gastroenterology 101(6): 1260-1267. June 2006.