Seniors and Hepatitis C


Hepatitis C is not just a disease of young people. Seniors (people over 60
years old) who are infected with HCV face particular challenges, both in the
progression of the disease and their options for treatment.

Clinical Studies of HCV in the Elderly

One small study found that seniors with hepatitis C infection are likely to have
more fibrosis than younger people infected with HCV, and that older people tend
to have higher viral loads than younger people.

This study did not find a significant difference in distribution of genotypes
between older and younger populations, and found that there was no significant
difference in the efficacy rate of IFN (interferon) in the elderly and younger
groups after other variables were taken into account.

An Italian study of over 1000 senior patients found that those infected with HCV
were most likely to have acquired the infection through blood transfusion,
surgical intervention and the use of non-disposable syringes.

Diagnostic testing of this group of Italian patients found that over 60 percent
were genotype 2, and that only about a third of the group had abnormal liver
enzymes and ultrasound results, suggesting the possibility that these elderly
patients might be HCV carriers.

Another review found that HCV infection is generally a mild disease in the
elderly, and suggests that many older HCV patients have compensated (stable)
liver disease.

These authors suggest that combination of compensated disease and the relatively
low response rates to interferon mean that the drug "should be reserved for
those with the best chance of response."

Researchers in Japan examined 135 patients over the age of 80 who were diagnosed
with liver disease. The majority of study participants had both HCV infection
and cirrhosis.

The researchers assessed the participants for the development of liver cancer,
and found that 32 percent of those with cirrhosis had developed liver cancer by
year 7 of the study. Their conclusion is that the presence of cirrhosis in this
elderly group was a major risk factor for the development of liver cancer.

Treatment Considerations

Treatment with alpha interferons and peginterferons, such as PEG-Intron
(Schering) and Pegasys (Roche), is associated with neuropsychiatric, cardiac,
pulmonary, gastrointestinal and systemic (flu-like) adverse effects.

These adverse reactions to interferon medications may be more severe in the
elderly, and physicians must use caution when prescribing these medications to
older people. In general, younger patients tend to respond better than older
patients to interferon-based therapies.

Interferon medications are excreted by the kidneys. Older patients are more
likely to have decreased renal function, and so the risk of toxic reactions to
this drug may be increased in this patient group.

For patients with very advanced liver disease, either due to hepatitis C
infection or liver cancer, transplantation may be necessary. While older age
does not rule out liver transplantation, older patients have a significantly
lower rate of survival after liver transplant.

One study determined that cancer is a primary cause of the decreased survival
rate after transplant, and that older age and smoking were the variables most
associated with the development of post-transplant cancer.

Conclusions

People greater than 60 years old should be considered for treatment of chronic
hepatitis on an individual basis. The benefit of treatment has not been well
documented and side effects appear to be worse in older people.

Also, older people are more likely to suffer from other medical conditions, such
as heart and kidney disease, and take several medicines already. These factors
can affect response to hepatitis treatment and increases the possibility of side
effects.

Source





Sandra Tara Balduf (Ane)

Frontline Hepatitis Awareness

Support for patients and educational materials

http://frontline-hepatitis-awareness.com

1-866-Hep-GoGo 866-437-4646




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