Hepatitis C virus in the elderly in the direct-acting antiviral era: from diagnosis to cure
Mohammed Abdul MK, Snyder HS, Chunduru M, Lee SMK, Satapathy SK. Hepatitis C Virus in the Elderly in the Direct-Acting Antiviral Era: from Diagnosis to Cure. Curr Treat Options Infect Dis. 2020 Aug 11:1-14. doi: 10.1007/s40506-020-00231-8. Epub ahead of print.
Purpose of review: Hepatitis C (HCV) is the most common cause of viral hepatitis in elderly individuals. This patient population previously experienced suboptimal outcomes with interferon-based regimens. Unfortunately, patients aged 65 years and older were underrepresented in phase 2 and 3 clinical trials with newer direct acting antiviral (DAA) therapies. Since the advent of second-generation DAA in 2013, numerous robust real-world experiences highlighting the efficacy and safety of DAA in the elderly have been published. This review article summarizes the cascade of care for hepatitis C from diagnosis to cure from an evidence-based perspective of the aging population.
Recent finding: In a large study from the Veterans Affairs Healthcare System, the overall sustained virologic response (SVR) of 15,884 patients treated with DAA regimens was 91.2%. These newer therapies remained highly effective in the subset of patients aged 65 years and older with SVR rates above 90%. A Spanish National Registry reported outcomes in patients ≥ 65 years old treated for HCV with oral DAA regimens over a 2-year period. The overall SVR was 94% in the study of 1252 subjects.
Summary: Current real-world data imply DAA treatment regimens remain highly effective and safe in elderly patients when compared to the general population.